Tablet ultrasound system

ABSTRACT

Exemplary embodiments provide systems and methods for portable medical ultrasound imaging. Preferred embodiments utilize a tablet touchscreen display operative to control imaging and display operations without the need for using traditional keyboards or controls. Certain embodiments provide ultrasound imaging system in which the scan head includes a beamformer circuit that performs far field sub array beamforming or includes a sparse array selecting circuit that actuates selected elements. Exemplary embodiments also provide an ultrasound engine circuit board including one or more multi-chip modules, and a portable medical ultrasound imaging system including an ultrasound engine circuit board with one or more multi-chip modules. Exemplary embodiments also provide methods for using a hierarchical two-stage or three-stage beamforming system, three dimensional ultrasound images which can be generated in real-time.

CROSS REFERENCE TO RELATED APPLICATIONS

This application is a continuation-in-part of PCT ApplicationPCT/US2013/033941 filed Mar. 26, 2013, and of U.S. application Ser. No.13/838,694 filed Mar. 15, 2013, and claims priority to U.S. ProvisionalApplication No. 61/615,627, filed Mar. 26, 2012 and U.S. ProvisionalApplication No. 61/704,254, filed Sep. 21, 2012, these applicationsbeing incorporated herein by reference in their entirety.

BACKGROUND OF THE INVENTION

Medical ultrasound imaging has become an industry standard for manymedical imaging applications. In recent years, there has been anincreasing need for medical ultrasound imaging equipment that isportable to allow medical personnel to easily transport the equipment toand from hospital and/or field locations, and more user-friendly toaccommodate medical personnel who may possess a range of skill levels.

Conventional medical ultrasound imaging equipment typically includes atleast one ultrasound probe/transducer, a keyboard and/or a knob, acomputer, and a display. In a typical mode of operation, the ultrasoundprobe/transducer generates ultrasound waves that can penetrate tissue todifferent depths based on frequency level, and receives ultrasound wavesreflected back from the tissue. Further, medical personnel can entersystem inputs to the computer via the keyboard and/or the knob, and viewultrasound images of tissue structures on the display.

However, conventional medical ultrasound imaging equipment that employsuch keyboards and/or knobs can be bulky, and therefore may not beamenable to portable use in hospital and/or field locations. Moreover,because such keyboards and/or knobs typically have uneven surfaces, theycan be difficult to keep clean in hospital and/or field environments,where maintenance of a sterile field can be crucial to patient health.Some conventional medical ultrasound imaging equipment have incorporatedtouch screen technology to provide a partial user input interface.However, conventional medical ultrasound imaging equipment that employsuch touch screen technology generally provide only limited touch screenfunctionality in conjunction with a traditional keyboard and/or knob,and can therefore not only be difficult to keep clean, but alsocomplicated to use.

SUMMARY OF THE INVENTION

In accordance with the present application, systems and methods ofmedical ultrasound imaging are disclosed. The presently disclosedsystems and methods of medical ultrasound imaging employ medicalultrasound imaging equipment that includes a handheld housing in atablet form factor, and a touch screen display disposed on a front panelof the housing. The touch screen display includes a multi-touchtouchscreen that can recognize and distinguish one or more single,multiple, and/or simultaneous touches on a surface of the touch screendisplay, thereby allowing the use of gestures, ranging from simplesingle point gestures to complex multipoint moving gestures, as userinputs to the medical ultrasound imaging equipment.

In accordance with one aspect, exemplary medical ultrasound imagingsystem includes a housing having a front panel and a rear panel rigidlymounted to each other in parallel planes, a touch screen display, acomputer having at least one processor and at least one memory, anultrasound beamforming system, and a battery. The housing of the medicalultrasound imaging equipment is implemented in a tablet form factor. Thetouch screen display is disposed on the front panel of the housing, andincludes a multi-touch LCD touch screen that can recognize anddistinguish one or more single, multiple, and/or simultaneous touches orgestures on a surface of the touch screen display. The computer, theultrasound beamforming system or engine, and the battery are operativelydisposed within the housing. The medical ultrasound imaging equipmentcan use a Firewire connection operatively connected between the computerand the ultrasound engine within the housing and a probe connectorhaving a probe attach/detach lever to facilitate the connection of atleast one ultrasound probe/transducer. In addition, the exemplarymedical ultrasound imaging system includes an I/O port connector and aDC power input.

In an exemplary mode of operation, medical personnel can employ simplesingle point gestures and/or more complex multipoint gestures as userinputs to the multi-touch LCD touch screen for controlling operationalmodes and/or functions of the exemplary medical ultrasound imagingequipment. Such single point/multipoint gestures can correspond tosingle and/or multipoint touch events that are mapped to one or morepredetermined operations that can be performed by the computer and/orthe ultrasound engine. Medical personnel can make such singlepoint/multipoint gestures by various finger, palm, and/or stylus motionson the surface of the touch screen display. The multi-touch LCD touchscreen receives the single point/multipoint gestures as user inputs, andprovides the user inputs to the computer, which executes, using theprocessor, program instructions stored in the memory to carry out thepredetermined operations associated with the single point/multipointgestures, at least at some times, in conjunction with the ultrasoundengine. Such single point/multipoint gestures on the surface of thetouch screen display can include, but are not limited to, a tap gesture,a pinch gesture, a flick gesture, a rotate gesture, a double tapgesture, a spread gesture, a drag gesture, a press gesture, a press anddrag gesture, and a palm gesture. In contrast to existing ultrasoundsystems that rely on numerous control features operated by mechanicalswitching, keyboard elements, or touchpad trackball interface, preferredembodiments of the present invention employ a single on/off switch. Allother operations have been implemented using touchscreen controls.Moreover, the preferred embodiments employ a capacitive touchscreendisplay that is sufficiently sensitive to detect touch gestures actuatedby bare fingers of the user as well as gloved fingers of the user. Oftenmedical personnel must wear sterilized plastic gloves during medicalprocedures. Consequently, it is highly desirable to provide a portableultrasound device that can be used by gloved hands; however, this haspreviously prevented the use of touchscreen display control functions inultrasound systems for many applications requiring sterile precautions.Preferred embodiments of the present invention provide control of allultrasound imaging operations by gloved personnel on the touchscreendisplay using the programmed touch gestures.

In accordance with an exemplary aspect, at least one flick gesture maybe employed to control the depth of tissue penetration of ultrasoundwaves generated by the ultrasound probe/transducer. For example, asingle flick gesture in the “up” direction on the touch screen displaysurface can increase the penetration depth by one (1) centimeter or anyother suitable amount, and a single flick gesture in the “down”direction on the touch screen display surface can decrease thepenetration depth by one (1) centimeter or any other suitable amount.Further, a drag gesture in the “up” or “down” direction on the touchscreen display surface can increase or decrease the penetration depth inmultiples of one (1) centimeter or any other suitable amount.

Additional operational modes and/or functions controlled by specificsingle point/multipoint gestures on the touch screen display surface caninclude, but are not limited to, freeze/store operations, 2-dimensionalmode operations, gain control, color control, split screen control, PWimaging control, cine/time-series image clip scrolling control, zoom andpan control, full screen control, Doppler and 2-dimensional beamsteering control, and/or body marking control. At least some of theoperational modes and/or functions of the exemplary medical ultrasoundimaging equipment can be controlled by one or more touch controlsimplemented on the touch screen display in which beamforming parameterscan be reset by moving touch gestures. Medical personnel can provide oneor more specific single point/multipoint gestures as user inputs forspecifying at least one selected subset of the touch controls to beimplemented, as required and/or desired, on the touch screen display. Alarger number of touchscreen controls enable greater functionality whenoperating in full screen mode when a few or more virtual buttons oricons are available for use.

In accordance with another exemplary aspect, a press gesture can beemployed inside a region of the touch screen display, and, in responseto the press gesture, a virtual window can be provided on the touchscreen display for displaying at least a magnified portion of anultrasound image displayed on the touch screen display. In accordancewith still another exemplary aspect, a press and drag gesture can beemployed inside the region of the touch screen display, and, in responseto the press and drag gesture, a predetermined feature of the ultrasoundimage can be traced. Further, a tap gesture can be employed inside theregion of the touch screen display, substantially simultaneously with aportion of the press and drag gesture, and, in response to the tapgesture, the tracing of the predetermined feature of the ultrasoundimage can be completed. These operations can operate in differentregions of a single display format, so that a moving gesture within aregion of interest within the image, for example, may perform adifferent function than the same gesture executed within the image butoutside the region of interest.

By providing medical ultrasound imaging equipment with a multi-touchtouchscreen, medical personnel can control the equipment using simplesingle point gestures and/or more complex multipoint gestures, withoutthe need of a traditional keyboard or knob. Because the multi-touchtouch screen obviates the need for a traditional keyboard or knob, suchmedical ultrasound imaging equipment is easier to keep clean in hospitaland/or field environments, provides an intuitive user friendlyinterface, while providing fully functional operations. Moreover, byproviding such medical ultrasound imaging equipment in a tablet formfactor, medical personnel can easily transport the equipment betweenhospital and/or field locations.

Certain exemplary embodiments provide a multi-chip module for anultrasound engine of a portable medical ultrasound imaging system, inwhich a transmit/receive (TR) chip, a pre-amp/time gain compensation(TGC) chip and a beamformer chip are assembled in a vertically stackedconfiguration. The transmission circuit provides high voltage electricaldriving pulses to the transducer elements to generate a transmit beam.As the transmit chip operates at voltages greater than 80V, a CMOSprocess utilizing a 1 micron design rule has been utilized for thetransmit chip and a submicron design rule has been utilized for thelow-voltage receiving circuits (less than 5V).

Preferred embodiments of the present invention utilize a submicronprocess to provide integrated circuits with sub-circuits operating at aplurality of voltages, for example, 2.5V, 5V and 60V or higher. Thesefeatures can be used in conjunction with a bi-plane transducer probe inaccordance with certain preferred embodiments of the invention.

Thus, a single IC chip can be utilized that incorporates high voltagetransmission, low voltage amplifier/TGC and low voltage beamformingcircuits in a single chip. Using a 0.25 micron design rule, this mixedsignal circuit can accommodate beamforming of 32 transducer channels ina chip area less than 0.7×0.7 (0.49) cm². Thus, 128 channels can beprocessed using four 32 channel chips in a total circuit board area ofless than 1.5×1.5 (2.25) cm².

The term “multi-chip module,” as used herein, refers to an electronicpackage in which multiple integrated circuits (IC) are packaged with aunifying substrate, facilitating their use as a single component, i.e.,as a higher processing capacity IC packaged in a much smaller volume.Each IC can comprise a circuit fabricated in a thinned semiconductorwafer. Exemplary embodiments also provide an ultrasound engine includingone or more such multi-chip modules, and a portable medical ultrasoundimaging system including an ultrasound engine circuit board with one ormore multi-chip modules. Exemplary embodiments also provide methods forfabricating and assembling multi-chip modules as taught herein.Vertically stacking the TR chip, the pre-amp/TGC chip, and thebeamformer chip on a circuit board minimizes the packaging size (e.g.,the length and width) and the footprint occupied by the chips on thecircuit board.

The TR chip, the pre-amp/TGC chip, and the beamformer chip in amulti-chip module may each include multiple channels (for example, 8channels per chip to 64 channels per chip). In certain embodiments, thehigh-voltage TR chip, the pre-amp/TGC chip, and the sample-interpolatereceive beamformer chip may each include 8, 16, 32, 64 channels. In apreferred embodiment, each circuit in a two layer beamformer module has32 beamformer receive channels to provide a 64 channel receivingbeamformer. A second 64 channel two layer module can be used to form a128 channel handheld tablet ultrasound device having an overallthickness of less than 2 cm. A transmit multi-chip beamformer can alsobe used having the same or similar channel density in each layer.

Exemplary numbers of chips vertically integrated in a multi-chip modulemay include, but are not limited to, two, three, four, five, six, seven,eight, and the like. In one embodiment of an ultrasound device, a singlemulti-chip module is provided on a circuit board of an ultrasound enginethat performs ultrasound-specific operations. In other embodiments, aplurality of multi-chip modules are provided on a circuit board of anultrasound engine. The plurality of multi-chip modules may be stackedvertically on top of one another on the circuit board of the ultrasoundengine to further minimize the packaging size and the footprint of thecircuit board.

Providing one or more multi-chip modules on a circuit board of anultrasound engine achieves a high channel count while minimizing theoverall packaging size and footprint. For example, a 128-channelultrasound engine circuit board can be assembled, using multi-chipmodules, within exemplary planar dimensions of about 10 cm× about 10 cm,which is a significant improvement over the much larger spacerequirements of conventional ultrasound circuits. A single circuit boardof an ultrasound engine including one or more multi-chip modules mayhave 16 to 128 channels in some embodiments. In certain embodiments, asingle circuit board of an ultrasound engine including one or moremulti-chip modules may have 16, 32, 64, 128 or 192 channels, and thelike.

BRIEF DESCRIPTION OF THE DRAWINGS

The foregoing and other objects, aspects, features, and advantages ofexemplary embodiments will become more apparent and may be betterunderstood by referring to the following description taken inconjunction with the accompanying drawings, in which:

FIG. 1 is a plan view of exemplary medical ultrasound imaging equipment,in accordance with an exemplary embodiment of the present application;

FIGS. 2A and 2B are side views of the medical ultrasound imaging systemin accordance with preferred embodiments of the invention;

FIG. 3A illustrates exemplary single point and multipoint gestures thatcan be employed as user inputs to the medical ultrasound imaging systemin accordance with preferred embodiments of the invention;

FIG. 3B illustrates a process flow diagram for operating a tabletultrasound system in accordance with preferred embodiments of theinvention;

FIG. 3C-3K illustrates details of touchscreen gestures to adjustbeamforming and display operation;

FIGS. 4A-4C illustrates exemplary subsets of touch controls that can beimplemented on the medical ultrasound imaging system in accordance withpreferred embodiments of the invention;

FIGS. 5A and 5B are exemplary representations of a liver with a cysticlesion on a touch screen display of the medical ultrasound imagingsystem in accordance with preferred embodiments of the invention;

FIGS. 5C and 5D are exemplary representations of the liver and cysticlesion on the touch screen display of FIGS. 5A and 5B, including avirtual window that corresponds to a magnified portion of the liver;

FIG. 6A is an exemplary representation of an apical four (4) chamberview of a heart on the touch screen display of the medical ultrasoundimaging system;

FIGS. 6B-6E illustrates an exemplary manual tracing of an endocardialborder of a left ventricle of the heart on the touch screen display ofFIG. 6A;

FIGS. 7A-7C illustrates an exemplary measurement of the size of thecystic lesion on the liver within the virtual window of FIGS. 5C and 5D;

FIGS. 8A-8C illustrates an exemplary caliper measurement of the cysticlesion on the liver within the virtual window of FIGS. 5C and 5D;

FIG. 9A illustrates one of a plurality of transducer arrays attached tothe processor housing;

FIG. 9B shows a transducer attach sequence in accordance with exemplaryembodiments;

FIG. 9C shows a perspective view of a needle sensing positioning systemwith exemplary embodiments;

FIG. 9D shows a perspective view of a needle guide with exemplaryembodiments;

FIG. 9E shows a perspective view of a needle sensing positioning systemwith exemplary embodiments;

FIG. 10A shows a method of measuring heart wall motion;

FIG. 10B shows a schematic block diagram for an integrated ultrasoundprobe with exemplary embodiments;

FIG. 10C shows a schematic block diagram for an integrated ultrasoundprobe with exemplary embodiments;

FIG. 11 is a detailed schematic block diagram of an exemplary embodimentof an ultrasound engine (i.e., the front-end ultrasound specificcircuitry) and an exemplary embodiment of a computer motherboard (i.e.,the host computer) of the exemplary ultrasound device;

FIG. 12 depicts a schematic side view of a circuit board including amulti-chip module assembled in a vertically stacked configuration;

FIG. 13 is a flowchart of an exemplary method for fabricating a circuitboard including a multi-chip module assembled in a vertically stackedconfiguration;

FIG. 14A is a schematic side view of a multi-chip module including fourvertically stacked dies in which the dies are spacedly separated fromone another by passive silicon layers with a 2-in-1 dicing die attachfilm (D-DAF);

FIG. 14B is a schematic side view of a multi-chip module including fourvertically stacked dies in which the dies are spacedly separated fromone another by DA film-based adhesives acting as die-to-die spacers;

FIG. 14C is a schematic side view of a multi-chip module including fourvertically stacked dies in which the dies are spacedly separated fromone another by DA paste or film-based adhesives acting as die-to-diespacers;

FIG. 15 is a flowchart of another exemplary method of die-to-diestacking using (a) passive silicon layers with a 2-in-1 dicing dieattach film (D-DAF), (b) DA paste, (c) thick DA-film, and (d) film-overwire (FOW) including a 2-in-1 D-DAF;

FIG. 16 is a schematic side view of a multi-chip module including anultrasound transmit/receive IC chip, an amplifier IC chip and anultrasound beamformer IC chip vertically integrated in a verticallystacked configuration;

FIG. 17 is a detailed schematic block diagram of an exemplary embodimentof an ultrasound engine (i.e., the front-end ultrasound specificcircuitry) and an exemplary embodiment of a computer motherboard (i.e.,the host computer) provided as a single board complete ultrasoundsystem;

FIG. 18 is a perspective view of an exemplary portable ultrasound systemprovided in accordance with exemplary embodiments;

FIG. 19 illustrates an exemplary view of a main graphical user interface(GUI) rendered on a touch screen display of the exemplary portableultrasound system of FIG. 18;

FIG. 20 is a top view of the medical ultrasound imaging system inaccordance with another preferred embodiment of the invention;

FIG. 21 illustrates a preferred cart system for a tablet ultrasoundsystem in accordance with preferred embodiment 9 of the invention;

FIG. 22 illustrates preferred cart system for a modular ultrasoundimaging system in accordance with preferred embodiments of theinvention;

FIG. 23 illustrates preferred cart system for a modular ultrasoundimaging system in accordance with preferred embodiments of theinvention;

FIG. 24 illustrates preferred cart system for a modular ultrasoundimaging system in accordance with preferred embodiments of theinvention;

FIGS. 25A-25B illustrate a multifunction docking base for tabletultrasound device;

FIG. 26 illustrates a 2D imaging mode of operation with a modularultrasound imaging system in accordance with the invention;

FIG. 27 illustrates a motion mode of operation with a modular ultrasoundimaging system in accordance with the invention;

FIG. 28 illustrates a color Doppler mode of operation with a modularultrasound imaging system in accordance with the invention;

FIG. 29 illustrates a pulsed-wave Doppler mode of operation with amodular ultrasound imaging system in accordance with the invention;

FIG. 30 illustrates a Triplex scan mode of operation with a modularultrasound imaging system in accordance with the invention;

FIG. 31 illustrates a GUI Home Screen interface for a user mode ofoperation with a modular ultrasound imaging system in accordance withthe invention;

FIG. 32 illustrates a GUI Menu Screen Interface for a user mode ofoperation with a modular ultrasound imaging system in accordance withthe invention;

FIG. 33 illustrates a GUI Patient Data Screen Interface for a user modeof operation with a modular ultrasound imaging system in accordance withthe invention;

FIG. 34 illustrates a GUI Pre-sets Screen Interface for a user mode ofoperation with a modular ultrasound imaging system in accordance withthe invention;

FIG. 35 illustrates a GUI Review Screen Interface for a user mode ofoperation with a modular ultrasound imaging system in accordance withthe invention;

FIG. 36 illustrates a GUI Report Screen Interface for a user mode ofoperation with a modular ultrasound imaging system in accordance withthe invention;

FIGS. 37A-37C illustrates a GUI Setup Display Screen Interface for auser mode of operation with a modular ultrasound imaging system inaccordance with the invention;

FIG. 38 illustrates a GUI Setup Store/Acquire Screen Interface for auser mode of operation with a modular ultrasound imaging system inaccordance with the invention;

FIGS. 39A-39C illustrate XY bi-plane probe comprising a twoone-dimensional, ID multi-element arrays in accordance with a preferredembodiment of the invention;

FIG. 40 illustrates the operation of a bi-plane image forming xy-probe;

FIG. 41 illustrates the operation of a bi-plane image forming xy-probe;

FIG. 42 illustrates a high voltage driver circuit for a bi-plane imageforming xy-probe;

FIGS. 43A-43B illustrate simultaneous bi-plane evaluation of leftventricular condition; and

FIGS. 44A-44B illustrate ejection fraction probe measurement techniquesin accordance with preferred embodiments of the invention;

DETAILED DESCRIPTION

Systems and methods of medical ultrasound imaging are disclosed. Thepresently disclosed systems and methods of medical ultrasound imagingemploy medical ultrasound imaging equipment that includes housing in atablet form factor, and a touch screen display disposed on a front panelof the housing. The touch screen display includes a multi-touch touchscreen that can recognize and distinguish one or more single, multiple,and/or simultaneous touches on a surface of the touch screen display,thereby allowing the use of gestures, ranging from simple single pointgestures to complex multipoint gestures, as user inputs to the medicalultrasound imaging equipment. Further details regarding tabletultrasound systems and operations are described in U.S. application Ser.No. 10/997,062 filed on Nov. 11, 2004, 10/386,360 filed Mar. 11, 2003and U.S. Pat. No. 6,969,352, the entire contents of these patents andapplications are incorporated herein by reference.

FIG. 1 depicts an illustrative embodiment of exemplary medicalultrasound imaging equipment 100, in accordance with the presentapplication. As shown in FIG. 1, the medical ultrasound imagingequipment 100 includes a housing 102, a touch screen display 104, acomputer having at least one processor and at least one memoryimplemented on a computer motherboard 106, an ultrasound engine 108, anda battery 110. For example, the housing 102 can be implemented in atablet form factor, or any other suitable form factor. The housing 102has a front panel 101 and a rear panel 103. The touch screen display 104is disposed on the front panel 101 of the housing 102, and includes amulti-touch LCD touch screen that can recognize and distinguish one ormore multiple and/or simultaneous touches on a surface 105 of the touchscreen display 104. The computer motherboard 106, the ultrasound engine108, and the battery 110 are operatively disposed within the housing102. The medical ultrasound imaging equipment 100 further includes aFirewire connection 112 (see also FIG. 2A) operatively connected betweenthe computer motherboard 106 and the ultrasound engine 108 within thehousing 102, and a probe connector 114 having a probe attach/detachlever 115 (see also FIGS. 2A and 2B) to facilitate the connection of atleast one ultrasound probe/transducer. The transducer probe housing caninclude circuit components including a transducer array, transmit andreceive circuitry, as well as beamformer and beamformer control circuitsin certain preferred embodiments. In addition, the medical ultrasoundimaging equipment 100 has one or more I/O port connectors 116 (see FIG.2A), which can include, but are not limited to, one or more USBconnectors, one or more SD cards, one or more network ports, one or moremini display ports, and a DC power input.

In an exemplary mode of operation, medical personnel (also referred toherein as the “user” or “users”) can employ simple single point gesturesand/or more complex multipoint gestures as user inputs to themulti-touch LCD touch screen of the touch screen display 104 forcontrolling one or more operational modes and/or functions of themedical ultrasound imaging equipment 100. Such a gesture is definedherein as a movement, a stroke, or a position of at least one finger, astylus, and/or a palm on the surface 105 of the touch screen display104. For example, such single point/multipoint gestures can includestatic or dynamic gestures, continuous or segmented gestures, and/or anyother suitable gestures. A single point gesture is defined herein as agesture that can be performed with a single touch contact point on thetouch screen display 104 by a single finger, a stylus, or a palm. Amultipoint gesture is defined herein as a gesture that can be performedwith multiple touch contact points on the touch screen display 104 bymultiple fingers, or any suitable combination of at least one finger, astylus, and a palm. A static gesture is defined herein as a gesture thatdoes not involve the movement of at least one finger, a stylus, or apalm on the surface 105 of the touch screen display 104. A dynamicgesture is defined herein as a gesture that involves the movement of atleast one finger, a stylus, or a palm, such as the movement caused bydragging one or more fingers across the surface 105 of the touch screendisplay 104. A continuous gesture is defined herein as a gesture thatcan be performed in a single movement or stroke of at least one finger,a stylus, or a palm on the surface 105 of the touch screen display 104.A segmented gesture is defined herein as a gesture that can be performedin multiple movements or stokes of at least one finger, a stylus, or apalm on the surface 105 of the touch screen display 104.

Such single point/multipoint gestures performed on the surface 105 ofthe touch screen display 104 can correspond to single or multipointtouch events, which are mapped to one or more predetermined operationsthat can be performed by the computer and/or the ultrasound engine 108.Users can make such single point/multipoint gestures by various singlefinger, multi-finger, stylus, and/or palm motions on the surface 105 ofthe touch screen display 104. The multi-touch LCD touch screen receivesthe single point/multipoint gestures as user inputs, and provides theuser inputs to the processor, which executes program instructions storedin the memory to carry out the predetermined operations associated withthe single point/multipoint gestures, at least at some times, inconjunction with the ultrasound engine 108. As shown in FIG. 3A, suchsingle point/multipoint gestures on the surface 105 of the touch screendisplay 104 can include, but are not limited to, a tap gesture 302, apinch gesture 304, a flick gesture 306, 314, a rotate gesture 308, 316,a double tap gesture 310, a spread gesture 312, a drag gesture 318, apress gesture 320, a press and drag gesture 322, and/or a palm gesture324. For example, such single point/multipoint gestures can be stored inat least one gesture library in the memory implemented on the computermotherboard 106. The computer program operative to control systemoperations can be stored on a computer readable medium and canoptionally be implemented using a touch processor connected to an imageprocessor and a control processor connected to the system beamformer.Thus beamformer delays associated with both transmission and receptioncan be adjusted in response to both static and moving touch gestures.

In accordance with the illustrative embodiment of FIG. 1, at least oneflick gesture 306 or 314 may be employed by a user of the medicalultrasound imaging equipment 100 to control the depth of tissuepenetration of ultrasound waves generated by the ultrasoundprobe/transducer. For example, a dynamic, continuous, flick gesture 306or 314 in the “up” direction, or any other suitable direction, on thesurface 105 of the touch screen display 104 can increase the penetrationdepth by one (1) centimeter, or any other suitable amount. Further, adynamic, continuous, flick gesture 306 or 314 in the “down” direction,or any other suitable direction, on the surface 105 of the touch screendisplay 104 can decrease the penetration depth by one (1) centimeter, orany other suitable amount. Moreover, a dynamic, continuous, drag gesture318 in the “up” or “down” direction, or any other suitable direction, onthe surface 105 of the touch screen display 104 can increase or decreasethe penetration depth in multiple centimeters, or any other suitableamounts.

Additional operational modes and/or functions controlled by specificsingle point/multipoint gestures on the surface 105 of the touch screendisplay 104 can include, but are not limited to, freeze/storeoperations, 2-dimensional mode operations, gain control, color control,split screen control, PW imaging control, cine/time-series image clipscrolling control, zoom and pan control, full screen display, Dopplerand 2-dimensional beam steering control, and/or body marking control. Atleast some of the operational modes and/or functions of the medicalultrasound imaging equipment 100 can be controlled by one or more touchcontrols implemented on the touch screen display 104. Further, users canprovide one or more specific single point/multipoint gestures as userinputs for specifying at least one selected subset of the touch controlsto be implemented, as required and/or desired, on the touch screendisplay 104.

Shown in FIG. 3B is a process sequence in which ultrasound beamformingand imaging operations 340 are controlled in response to touch gesturesentered on a touchscreen. Various static and moving touch gestures havebeen programmed into the system such that the data processor operable tocontrol beamforming and image processing operations 342 within thetablet device. A user can select 344 a first display operation having afirst plurality of touch gestures associated therewith. Using a staticor moving gesture the user can perform one of the plurality of gesturesoperable to control the imaging operation and can specifically selectone of a plurality of gestures that can adjust beamforming parameters346 being used to generate image data associated with the first displayoperation. The displayed image is updated and displayed 348 response tothe updated beamforming procedure. The user can further elect to performa different gesture having a different velocity characteristic(direction or speed or both) to adjust 350 a second characteristic ofthe first ultrasound display operation. The displayed image is thenupdated 352 based on the second gesture, which can modify imagingprocessing parameters or beamforming parameters. Examples of thisprocess are described in further detail herein where changes in velocityand direction of different gestures can be associated with distinctimaging parameters of a selected display operation.

Ultrasound images of flow or tissue movement, whether color flow orspectral Doppler, are essentially obtained from measurements ofmovement. In ultrasound scanners, a series of pulses is transmitted todetect movement of blood. Echoes from stationary targets are the samefrom pulse to pulse. Echoes from moving scatterers exhibit slightdifferences in the time for the signal to be returned to the scanner.

As can be seen from FIG. 3C-3H, there has to be motion in the directionof the beam; if the flow is perpendicular to the beam, there is norelative motion from pulse to pulse receive, there is no flow detected.These differences can be measured as a direct time difference or, moreusually, in terms of a phase shift from which the ‘Doppler frequency’ isobtained. They are then processed to produce either a color flow displayor a Doppler sonogram. In FIG. 3C-3D, the flow direction isperpendicular to the beam direction, no flow is measured by Pulse Wavespectral Doppler. In FIG. 3G-3H when the ultrasound beam is steered toan angle that is better aligned to the flow, a weak flow is shown in thecolor flow map, and in addition flow is measured by Pulse Wave Doppler.In FIG. 3H, when the ultrasound beam is steered to an angle much betteraligned to the flow direction in response to a moving, the color flowmap is stronger, in addition when the correction angle of the PWD isplaced aligned to the flow, a strong flow is measured by the PWD.

In this tablet ultrasound system, an ROI, region of interest, is alsoused to define the direction in response to a moving gesture of theultrasound transmit beam. A liver image with a branch of renal flow incolor flow mode is shown in FIG. 31 since the ROI is straight down fromthe transducer, the flow direction is almost normal to the ultrasoundbeam, so very week renal flow is detected. Hence, the color flow mode isused to image a renal flow in liver. As can be seen, the beam is almostnormal to the flow and very weak flow is detected. A flick gesture withthe finger outside of the ROI is used to steer the beam. As can be seenin FIG. 3J, the ROI is steered by resetting beamforming parameters sothat the beam direction is more aligned to the flow direction, a muchstronger flow within the ROI is detected. In FIG. 3J, a flick gesturewith the finger outside of the ROI is used to steer the ultrasound beaminto the direction more aligned to the flow direction. Stronger flowwithin the ROI can be seen. A panning gesture with the finger inside theROI will move the ROI box into a position that covers the entire renalregion, i.e., panning allows a translation movement of the ROI box suchthat the box covers the entire target area.

FIG. 3K demonstrates a panning gesture. With the finger inside the ROI,it can move the ROI box to any place within the image plane. In theabove embodiment, it is easy to differentiate a “flick” gesture with afinger outside an “ROI” box is intended for steering a beam, and a“drag-and-move, panning” gesture with a finger inside the “ROI” isintended for moving the ROI box. However, there are applications inwhich no ROI as a reference region, then it is easy to see that it isdifficult to differentiate a “flick” or a “panning” gesture, in thiscase, the touch-screen program needs to track the initial velocity oracceleration of the finger to determine it is a “flick” gesture or a“drag-and-move” gesture. Thus, the touch engine that receives data fromthe touchscreen sensor device is programmed to discriminate betweenvelocity thresholds that indicate different gestures. Thus, the time,speed and direction associated with different moving gestures can havepreset thresholds. Two and three finger static and moving gestures canhave separate thresholds to differentiate these control operations. Notethat preset displayed icons or virtual buttons can have distinct staticpressure or time duration thresholds. When operated in full screen mode,the touchscreen processor, which is preferably operating on the systemscentral processing unit that performs other imaging operations such asscan conversion, switches off the static icons.

FIGS. 4A-4C depict exemplary subsets 402, 404, 406 of touch controlsthat can be implemented by users of the medical ultrasound imagingequipment 100 on the touch screen display 104. It is noted that anyother suitable subset(s) of touch controls can be implemented, asrequired and/or desired, on the touch screen display 104. As shown inFIG. 4A, the subset 402 includes a touch control 408 for performing2-dimensional (2D) mode operations, a touch control 410 for performinggain control operations, a touch control 412 for performing colorcontrol operations, and a touch control 414 for performing image/clipfreeze/store operations. For example, a user can employ the pressgesture 320 to actuate the touch control 408, returning the medicalultrasound imaging equipment 100 to 2D mode. Further, the user canemploy the press gesture 320 against one side of the touch control 410to decrease a gain level, and employ the press gesture 320 againstanother side of the touch control 410 to increase the gain level.Moreover, the user can employ the drag gesture 318 on the touch control412 to identify ranges of densities on a 2D image, using a predeterminedcolor code. In addition, the user can employ the press gesture 320 toactuate the touch control 414 to freeze/store a still image or toacquire a cine image clip.

As shown in FIG. 4B, the subset 404 includes a touch control 416 forperforming split screen control operations, a touch control 418 forperforming PW imaging control operations, a touch control 420 forperforming Doppler and 2-dimensional beam steering control operations,and a touch control 422 for performing annotation operations. Forexample, a user can employ the press gesture 320 against the touchcontrol 416, allowing the user to toggle between opposing sides of thesplit touch screen display 104 by alternately employing the tap gesture302 on each side of the split screen. Further, the user can employ thepress gesture 320 to actuate the touch control 418 and enter the PWmode, which allows (1) user control of the angle correction, (2)movement (e.g., “up” or “down”) of a baseline that can be displayed onthe touch screen display 104 by employing the press and drag gesture322, and/or (3) an increase or a decrease of scale by employing the tapgesture 302 on a scale bar that can be displayed on the touch screendisplay 104. Moreover, the user can employ the press gesture 320 againstone side of the touch control 420 to perform 2D beam steering to the“left” or any other suitable direction in increments of five (5) or anyother suitable increment, and employ the press gesture 320 againstanother side of the touch control 420 to perform 2D beam steering to the“right” or any other suitable direction in increments of five (5) or anyother suitable increment. In addition, the user can employ the tapgesture 302 on the touch control 422, allowing the user to enterannotation information via a pop-up keyboard that can be displayed onthe touch screen display 104.

As shown in FIG. 4C, the subset 406 includes a touch control 424 forperforming dynamic range operations, a touch control 426 for performingTeravision™ software operations, a touch control 428 for performing mapoperations, and a touch control 430 for performing needle guideoperations. For example, a user can employ the press gesture 320 and/orthe press and drag gesture 322 against the touch control 424 to controlor set the dynamic range. Further, the user can employ the tap gesture302 on the touch control 426 to choose a desired level of theTeravision™ software to be executed from the memory by the processor onthe computer motherboard 106. Moreover, the user can employ the tapgesture 302 on the touch control 428 to perform a desired map operation.In addition, the user can employ the press gesture 320 against the touchcontrol 430 to perform a desired needle guide operation.

In accordance with the present application, various measurements and/ortracings of objects (such as organs, tissues, etc.) displayed asultrasound images on the touch screen display 104 of the medicalultrasound imaging equipment 100 (see FIG. 1) can be performed, usingsingle point/multipoint gestures on the surface 105 of the touch screendisplay 104. The user can perform such measurements and/or tracings ofobjects directly on an original ultrasound image of the displayedobject, on a magnified version of the ultrasound image of the displayedobject, and/or on a magnified portion of the ultrasound image within avirtual window 506 (see FIGS. 5C and 5D) on the touch screen display104.

FIGS. 5A and 5B depict an original ultrasound image of an exemplaryobject, namely, a liver 502 with a cystic lesion 504, displayed on thetouch screen display 104 of the medical ultrasound imaging equipment 100(see FIG. 1). It is noted that such an ultrasound image can be generatedby the medical ultrasound imaging equipment 100 in response topenetration of the liver tissue by ultrasound waves generated by anultrasound probe/transducer operatively connected to the equipment 100.Measurements and/or tracings of the liver 502 with the cystic lesion 504can be performed directly on the original ultrasound image displayed onthe touch screen display 104 (see FIGS. 5A and 5B), or on a magnifiedversion of the ultrasound image. For example, the user can obtain such amagnified version of the ultrasound image using a spread gesture (see,e.g., the spread gesture 312; FIG. 3) by placing two (2) fingers on thesurface 105 of the touch screen display 104, and spreading them apart tomagnify the original ultrasound image. Such measurements and/or tracingsof the liver 502 and cystic lesion 504 can also be performed on amagnified portion of the ultrasound image within the virtual window 506(see FIGS. 5C and 5D) on the touch screen display 104.

For example, using his or her finger (see, e.g., a finger 508; FIGS.5A-5D), the user can obtain the virtual window 506 by employing a pressgesture (see, e.g., the press gesture 320; FIG. 3) against the surface105 of the touch screen display 104 (see FIG. 5B) in the vicinity of aregion of interest, such as the region corresponding to the cysticlesion 504. In response to the press gesture, the virtual window 506(see FIGS. 5C and 5D) is displayed on the touch screen display 104,possibly at least partially superimposed on the original ultrasoundimage, thereby providing the user with a view of a magnified portion ofthe liver 502 in the vicinity of the cystic lesion 504. For example, thevirtual window 506 of FIG. 5C can provide a view of a magnified portionof the ultrasound image of the cystic lesion 504, which is covered bythe finger 508 pressed against the surface 105 of the touch screendisplay 104. To re-position the magnified cystic lesion 504 within thevirtual window 506, the user can employ a press and drag gesture (see,e.g., the press and drag gesture 322; FIG. 3) against the surface 105 ofthe touch screen display 104 (see FIG. 5D), thereby moving the image ofthe cystic lesion 504 to a desired position within the virtual window506. In one embodiment, the medical ultrasound imaging equipment 100 canbe configured to allow the user to select a level of magnificationwithin the virtual window 506 to be 2 times larger, 4 times larger, orany other suitable number of times larger than the original ultrasoundimage. The user can remove the virtual window 506 from the touch screendisplay 104 by lifting his or her finger (see, e.g., the finger 508;FIGS. 5A-5D) from the surface 105 of the touch screen display 104.

FIG. 6A depicts an ultrasound image of another exemplary object, namely,an apical four (4) chamber view of a heart 602, displayed on the touchscreen display 104 of the medical ultrasound imaging equipment 100 (seeFIG. 1). It is noted that such an ultrasound image can be generated bythe medical ultrasound imaging equipment 100 in response to penetrationof the heart tissue by ultrasound waves generated by an ultrasoundprobe/transducer operatively connected to the equipment 100.Measurements and/or tracings of the heart 602 can be performed directlyon the original ultrasound image displayed on the touch screen display104 (see FIGS. 6A-6E), or on a magnified version of the ultrasoundimage. For example, using his or her fingers (see, e.g., fingers 610,612; FIGS. 6B-6E), the user can perform a manual tracing of anendocardial border 604 (see FIG. 6B) of a left ventricle 606 (see FIGS.6B-6E) of the heart 602 by employing one or more multi-finger gestureson the surface 105 of the touch screen display 104. In one embodiment,using his or her fingers (see, e.g., the fingers 610, 612; FIGS. 6B-6E),the user can obtain a cursor 607 (see FIG. 6B) by employing a double tapgesture (see, e.g., the double tap gesture 310; FIG. 3A) on the surface105 of the touch screen display 104, and can move the cursor 607 byemploying a drag gesture (see, e.g., the drag gesture 318; FIG. 3A)using one finger, such as the finger 610, thereby moving the cursor 607to a desired location on the touch screen display 104. The systems andmethods described herein can be used for the quantitative measurement ofheart wall motion and specifically for the measurement of ventriculardysynchrony as described in detail in U.S. application Ser. No.10/817,316 filed on Apr. 2, 2004, the entire contents of which isincorporated herein by reference.

Once the cursor 607 is at the desired location on the touch screendisplay 104, as determined by the location of the finger 610, the usercan fix the cursor 607 at that location by employing a tap gesture (see,e.g., the tap gesture 302; see FIG. 3) using another finger, such as thefinger 612. To perform a manual tracing of the endocardial border 604(see FIG. 6B), the user can employ a press and drag gesture (see, e.g.,the press and drag gesture 322; FIG. 3) using the finger 610, asillustrated in FIGS. 6C and 6D. Such a manual tracing of the endocardialborder 604 can be highlighted on the touch screen display 104 in anysuitable fashion, such as by a dashed line 608 (see FIGS. 6C-6E). Themanual tracing of the endocardial border 604 can continue until thefinger 610 arrives at any suitable location on the touch screen display104, or until the finger 610 returns to the location of the cursor 607,as illustrated in FIG. 6E. Once the finger 610 is at the location of thecursor 607, or at any other suitable location, the user can complete themanual tracing operation by employing a tap gesture (see, e.g., the tapgesture 302; see FIG. 3) using the finger 612. It is noted that such amanual tracing operation can be employed to trace any other suitablefeature(s) and/or waveform(s), such as a pulsed wave Doppler (PWD)waveform. In one embodiment, the medical ultrasound imaging equipment100 can be configured to perform any suitable calculation(s) and/ormeasurement(s) relating to such feature(s) and/or waveform(s), based atleast in part on a manual tracing(s) of the respectivefeature(s)/waveform(s).

As described above, the user can perform measurements and/or tracings ofobjects on a magnified portion of an original ultrasound image of adisplayed object within a virtual window on the touch screen display104. FIGS. 7A-7C depict an original ultrasound image of an exemplaryobject, namely, a liver 702 with a cystic lesion 704, displayed on thetouch screen display 104 of the medical ultrasound imaging equipment 100(see FIG. 1). FIGS. 7A-7C further depict a virtual window 706 thatprovides a view of a magnified portion of the ultrasound image of thecystic lesion 704, which is covered by one of the user's fingers, suchas a finger 710, pressed against the surface 105 of the touch screendisplay 104. Using his or her fingers (see, e.g., fingers 710, 712;FIGS. 7A-7C), the user can perform a size measurement of the cysticlesion 704 within the virtual window 706 by employing one or moremulti-finger gestures on the surface 105 of the touch screen display104.

For example, using his or her fingers (see, e.g., the fingers 710, 712;FIGS. 7A-7C), the user can obtain a first cursor 707 (see FIGS. 7B, 7C)by employing a double tap gesture (see, e.g., the double tap gesture310; FIG. 3) on the surface 105, and can move the first cursor 707 byemploying a drag gesture (see, e.g., the drag gesture 318; FIG. 3) usingone finger, such as the finger 710, thereby moving the first cursor 707to a desired location. Once the first cursor 707 is at the desiredlocation, as determined by the location of the finger 710, the user canfix the first cursor 707 at that location by employing a tap gesture(see, e.g., the tap gesture 302; see FIG. 3) using another finger, suchas the finger 712. Similarly, the user can obtain a second cursor 709(see FIG. 7C) by employing a double tap gesture (see, e.g., the doubletap gesture 310; FIG. 3) on the surface 105, and can move the secondcursor 709 by employing a drag gesture (see, e.g., the drag gesture 318;FIG. 3) using the finger 710, thereby moving the second cursor 709 to adesired location. Once the second cursor 709 is at the desired location,as determined by the location of the finger 710, the user can fix thesecond cursor 709 at that location by employing a tap gesture (see,e.g., the tap gesture 302; see FIG. 3) using the finger 712. In oneembodiment, the medical ultrasound imaging equipment 100 can beconfigured to perform any suitable size calculation(s) and/ormeasurement(s) relating to the cystic lesion 704, based at least in parton the locations of the first and second cursors 707, 709.

FIGS. 8A-8C depict an original ultrasound image of an exemplary object,namely, a liver 802 with a cystic lesion 804, displayed on the touchscreen display 104 of the medical ultrasound imaging equipment 100 (seeFIG. 1). FIGS. 8 a-8 c further depict a virtual window 806 that providesa view of a magnified portion of the ultrasound image of the cysticlesion 804, which is covered by one of the user's fingers, such as afinger 810, pressed against the surface 105 of the touch screen display104. Using his or her fingers (see, e.g., fingers 810, 812; FIGS.8A-8C), the user can perform a caliper measurement of the cystic lesion804 within the virtual window 806 by employing one or more multi-fingergestures on the surface 105 of the touch screen display 104.

For example, using his or her fingers (see, e.g., the fingers 810, 812;FIGS. 8A-8C), the user can obtain a first cursor 807 (see FIGS. 8B, 8C)by employing a double tap gesture (see, e.g., the double tap gesture310; FIG. 3) on the surface 105, and can move the cursor 807 byemploying a drag gesture (see, e.g., the drag gesture 318; FIG. 3) usingone finger, such as the finger 810, thereby moving the cursor 807 to adesired location. Once the cursor 807 is at the desired location, asdetermined by the location of the finger 810, the user can fix thecursor 807 at that location by employing a tap gesture (see, e.g., thetap gesture 302; see FIG. 3) using another finger, such as the finger812. The user can then employ a press and drag gesture (see, e.g., thepress and drag gesture 322; FIG. 3) to obtain a connecting line 811 (seeFIGS. 8B, 8C), and to extend the connecting line 811 from the firstcursor 807 across the cystic lesion 804 to a desired location on anotherside of the cystic lesion 804. Once the connecting line 811 is extendedacross the cystic lesion 804 to the desired location on the other sideof the cystic lesion 804, the user can employ a tap gesture (see, e.g.,the tap gesture 302; see FIG. 3) using the finger 812 to obtain and fixa second cursor 809 (see FIG. 8C) at that desired location. In oneembodiment, the medical ultrasound imaging equipment 100 can beconfigured to perform any suitable caliper calculation(s) and/ormeasurement(s) relating to the cystic lesion 804, based at least in parton the connecting line 811 extending between the locations of the firstand second cursors 807, 809.

FIG. 9A shows a system 140 in which a transducer housing 150 with anarray of transducer elements 152 can be attached at connector 114 tohousing 102. Each probe 150 can have a probe identification circuit 154that uniquely identifies the probe that is attached. When the userinserts a different probe with a different array, the system identifiesthe probe operating parameters. Note that preferred embodiments caninclude a display 104 having a touch sensor 107 which can be connectedto a touch processor 109 that analyzes touchscreen data from the sensor107 and transmits commands to both image processing operations and to abeamformer control processor (1116, 1124). In a preferred embodiment,the touch processor can include a computer readable medium that storesinstructions to operate an ultrasound touchscreen engine that isoperable to control display and imaging operations described herein.

FIG. 9B shows a software flowchart 900 of a typical transducermanagement module 902 within the ultrasound application program. When aTRANSDUCER ATTACH 904 event is detected, the Transducer ManagementSoftware Module 902 first reads the Transducer type ID 906 and hardwarerevision information from the IDENTIFICATION Segment. The information isused to fetch the particular set of transducer profile data 908 from thehard disk and load it into the memory of the application program. Thesoftware then reads the adjustment data from the FACTORY Segment 910 andapplies the adjustments to the profile data just loaded into memory 912.The software module then sends a TRANSDUCER ATTACH Message 914 to themain ultrasound application program, which uses the transducer profilealready loaded. After acknowledgment 916, an ultrasound imaging sequenceis performed and the USAGE segment is updated 918. The TransducerManagement Software Module then waits for either a TRANSDUCER DETACHevent 920, or the elapse of 5 minutes. If a TRANSDUCER DETACH event isdetected 921, a message 924 is sent and acknowledged 926, the transducerprofile data set is removed 928 from memory and the module goes back towait for another TRANSDUCER ATTACH event. If a 5 minutes time periodexpires without detecting a TRANSDUCER DETACH event, the software moduleincrements a Cumulative Usage Counter in the USAGE Segment 922, andwaits for another 5 minutes period or a TRANSDUCER DETACH event. Thecumulative usage is recorded in memory for maintenance and replacementrecords.

There are many types of ultrasound transducers. They differ by geometry,number of elements, and frequency response. For example, a linear arraywith center frequency of 10 to 15 MHz is better suited for breastimaging, and a curved array with center frequency of 3 to 5 MHz isbetter suited for abdominal imaging.

It is often necessary to use different types of transducers for the sameor different ultrasound scanning sessions. For ultrasound systems withonly one transducer connection, the operator will change the transducerprior to the start of a new scanning session.

In some applications, it is necessary to switch among different types oftransducers during one ultrasound scanning session. In this case, it ismore convenient to have multiple transducers connected to the sameultrasound system, and the operator can quickly switch among theseconnected transducers by hitting a button on the operator console,without having to physically detach and re-attach the transducers, whichtakes a longer time. Preferred embodiments of the invention can includea multiplexor within the tablet housing that can select between aplurality of probe connector ports within the tablet housing, oralternatively, the tablet housing can be connected to an externalmultiplexor that can be mounted on a cart as described herein.

FIG. 9C is a perspective view of an exemplary needle sensing positioningsystem using ultrasound transducers without the requirement of anyactive electronics in the sensor assembly. The sensor transducer mayinclude a passive ultrasound transducer element. The elements may beused in a similar way as a typical transducer probe, utilizing theultrasound engine electronics. The system 958 includes the addition ofultrasound transducer elements 960, added to a needle guide 962, that isrepresented in FIG. 9C but that may be any suitable form factor. Theultrasound transducer element 960, and needle guide 962, may be mountedusing a needle guide mounting bracket 966, to an ultrasound transducerprobe acoustic handle or an ultrasound imagining probe assembly 970. Theneedle with a disc mounted on the exposed end, the ultrasound reflectordisc 964, is reflective to ultrasonic waves.

The ultrasound transducer element 960, on the needle guide 962, may beconnected to the ultrasound engine. The connection may be made through aseparate cable to a dedicated probe connector on the engine, similar toa sharing the pencil CW probe connector. In an alternate embodiment, asmall short cable may be plugged into the larger image transducer probehandle or a split cable connecting to the same probe connector at theengine. In another alternate embodiment the connection may be made viaan electrical connector between the image probe handle and the needleguide without a cable in between. In an alternate embodiment theultrasound transducer elements on the needle guide may be connected tothe ultrasound engine by enclosing the needle guide and transducerelements in the same mechanical enclosure of the imagining probe handle.

FIG. 9D is a perspective view of a needle guide 962, positioned withtransducer elements 960 and the ultrasound reflector disc 964. Theposition of the reflector disc 964 is located by transmitting ultrasonicwave 972, from the transducer element 960 on the needle guide 962. Theultrasound wave 972 travels through the air towards reflector disc 964and is reflected by the reflector disc 964. The reflected ultrasoundwave 974, reaches the transducer element 960 on the needle guide 962.The distance 976, between the reflector disc 964, and the transducerelement 960 is calculated from the time elapsed and the speed of soundin the air.

FIG. 9E is a perspective view of an alternate embodiment of theexemplary needle sensing positioning system using ultrasound transducerswithout the requirement of any active electronics in the sensorassembly. The sensor transducer may include a passive ultrasoundtransducer element. The elements may be used in a similar way as atypical transducer probe, utilizing the ultrasound engine electronics.

The system 986 includes needle guide 962 that may be mounted to a needleguide mounting bracket 966 that may be coupled to an ultrasound imagingprobe assembly for imaging the patient's body 982, or alternativesuitable form factors. The ultrasound reflector disc 964 may be mountedat the exposed end of the needle 956. In this embodiment a linearultrasound acoustic array 978, is mounted parallel to the direction ofmovement of the needle 956. The linear ultrasound acoustic array 978includes an ultrasound transducer array 980 positioned parallel to theneedle 956. In this embodiment an ultrasound imagining probe assembly982, is positioned for imagining the patient body. The ultrasoundimaging probe assembly for imaging the patient body 982 is configuredwith an ultrasound transducer array 984.

In this embodiment, the position of the ultrasound reflector disc 964can be detected by using the ultrasound transducer array 980 coupled toan ultrasound imaging probe assembly for imaging 978. The position ofthe reflector disc 964 is located by transmitting ultrasonic wave 972,from the transducer element 980 on the ultrasound imaging probe assemblyfor imaging 978. The ultrasound wave 972 travels through the air towardsreflector disc 964 and is reflected by the reflector disc 964. Thereflected ultrasound wave 974, reaches the transducer element 980 on theultrasound imaging probe assembly for imaging 978. The distance 976,between the reflector disc 964, and the transducer element 980 iscalculated from the time elapsed and the speed of sound in the air. Inan alternate embodiment an alternate algorithm may be used tosequentially scan the polarity of elements in the transducer array andanalyze the reflections produced per transducer array element. In analternate embodiment a plurality of scans may occur prior to forming anultrasound image.

FIG. 10A illustrates an exemplary method for monitoring the synchrony ofa heart in accordance with exemplary embodiments. In the method, areference template is loaded into memory and used to guide a user inidentifying an imaging plane (per step 930). Next a user identifies adesired imaging plane (per step 932). Typically an apical 4-chamber viewof the heart is used; however, other views may be used without departingfrom the spirit of the invention.

At times, identification of endocardial borders may be difficult, andwhen such difficulties are encountered tissue Doppler imaging of thesame view may be employed (per step 934). A reference template foridentifying the septal and lateral free wall is provided (per step 936).Next, standard tissue Doppler imaging (TDI) with pre-set velocity scalesof, say, ±30 cm/sec may be used (per step 938).

Then, a reference of the desired triplex image may be provided (per step940). Either B-mode or TDI may be used to guide the range gate (per step942). B-mode can be used for guiding the range gate (per step 944) orTDI for guiding the range gate (per step 946). Using TDI or B-mode forguiding the range gate also allows the use of a direction correctionangle for allowing the Spectral Doppler to display the radial meanvelocity of the septal wall. A first pulsed-wave spectral Doppler isthen used to measure the septal wall mean velocity using duplex ortriplex mode (per step 948). The software used to process the data andcalculate dysychrony can utilize a location (e.g. a center point) toautomatically set an angle between dated locations on a heart wall toassist in simplifying the setting of parameters.

A second range-gate position is also guided using a duplex image or aTDI (per step 950), and a directional correction angle may be used ifdesired. After step 950, the mean velocity of the septal wall andlateral free wall are being tracked by the system. Time integration ofthe Spectral Doppler mean velocities 952 at regions of interest (e.g.,the septum wall and the left ventricular free wall) then provides thedisplacement of the septal and left free wall, respectively.

The above method steps may be utilized in conjunction with a high passfiltering means, analog or digital, known in the relevant arts forremoving any baseline disturbance present in collected signals. Inaddition, the disclosed method employs multiple simultaneous PW SpectralDoppler lines for tracking movement of the interventricular septum andthe left ventricular fee wall. In additional, a multiple gate structuremay be employed along each spectral line, thus allowing quantitativemeasurement of regional wall motion. Averaging over multiple gates mayallow measurement of global wall movement.

FIG. 10B is a detailed schematic block diagram for an exemplaryembodiment of the integrated ultrasound probe 1040 can be connected toany PC 1010 through an Interface unit 1020. The ultra sound probe 1040is configured to transmit ultrasound waves to and reduce reflectedultrasound waves from on ore more image targets 1064. The transducer1040 can be coupled to the interface unit 1020 using one or more cables1066, 1068. The interface unit 1020 can be positioned between theintegrated ultrasound probe 1040 and the host computer 1010. The twostage beam forming system 1040 and 1020 can be connected to any PCthrough a USB connection 1022, 1012.

The ultrasound probe 1040, can include sub-arrays/apertures 1052consisting of neighboring elements with an aperture smaller than that ofthe whole array. Returned echoes are received by the 1D transducer array1062 and transmitted to the controller 1044. The controller initiatesformation of a coarse beam by transmitting the signals to memory 1058,1046. The memory 1058, 1046 transmits a signal to a transmit Driver 11050, and Transmit Driver m 1054. Transmit Driver 1 1050 and TransmitDriver m 1054 then send the signal to mux1 1048 and mux m 1056,respectively. The signal is transmitted to sub-array beamformer 1 1052and sub-array beamformer n 1060.

The outputs of each coarse beam forming operation can include furtherprocessing through a second stage beam forming in the interface unit1020 to convert the beam forming output to digital representation. Thecoarse beam forming operations can be coherently summed to form a finebeam output for the array. The signals can be transmitted from theultrasound probe 1040 sub-array beam former 1 1052 and sub-array beamformer n 1060 to the A/D convertors 1030 and 1028 within the interfaceunit 1020. Within the interface unit 1020 there are A/D converters 1028,1030 for converting the first stage beam forming output to digitalrepresentation. The digital conversion can be received from the A/Dconvertors 1030, 1028 by a customer ASIC such as a FPGA 1026 to completethe second stage beam forming. The FPGA Digital beam forming 1026 cantransmit information to the system controller 1024. The systemcontroller can transmit information to a memory 1032 which may send asignal back to the FPGA Digital Beam forming 1026. Alternatively, thesystem controller 1024 may transmit information to the custom USB3Chipset 1022. The USB3 Chipset 1022 may then transmit information to aDC-DC convertor 1034. In turn, the DC-DC convertor 1034 may transmitpower from the interface unit 1020 to the ultrasound probe 1040. Withinthe ultrasound probe 1040 a power supply 1042 may receive the powersignal and interface with the transmit driver 1 1050 to provide thepower to the front end integration probe.

The Interface unit 1020 custom or USB3 Chipset 1022 may be used toprovide a communication link between the interface unit 10220 and thehost computer 1010. The custom or USB3 Chipset 1022 transmits a signalto the host computer's 1010 custom or USB3 Chipset 1012. The custom orthe USB3 Chipset 1012 then interfaces with the microprocessor 1014. Themicroprocessor 1014 then may display information or send information toa device 1075.

In an alternate embodiment, a narrow band beamformer can be used. Forexample, an individual analog phase shifter is applied to each of thereceived echoes. The phase shifted outputs within each sub-array arethen summed to form a coarse beam. The A/D converts can be used todigitize each of the coarse beams; a digital beam former is then used toform the fine beam.

In another embodiment, forming a 64 element linear array may use eightadjacent elements to form a coarse beam output. Such arrangement mayutilize eight output analog cables connecting the outputs of theintegrated probe to the interface units. The coarse beams may be sentthrough the cable to the corresponding A/D convertors located in theinterface unit. The digital delay is used to form a fine beam output.Eight A/D convertors may be required to form the digital representation.

In another embodiment, forming a 128 element array may use sixteensub-array beam forming circuits. Each circuit may form a coarse beamfrom an adjacent eight element array provided in the first stage outputto the interface unit. Such arrangement may utilize sixteen outputanalog cables connecting the outputs of the integrated probe to theinterface units to digitize the output. A PC microprocessor or a DSP maybe used to perform the down conversion, base-banding, scan conversionand post image processing functions. The microprocessor or DSP can alsobe used to perform all the Doppler processing functions.

FIG. 10C is a detailed schematic block diagram for an exemplaryembodiment of the integrated ultrasound probe 1040 with the first subarray beamforming circuit, and the second stage beamforming circuits areintegrated inside the host computer 1082. The back end computer with thesecond stage beamforming circuit may be a PDA, tablet or mobile devicehousing. The ultra sound probe 1040 is configured to transmit ultrasoundwaves to and reduce reflected ultrasound waves from on ore more imagetargets 1064. The transducer 1040 is coupled to the host computer 1082using one or more cables 1066, 1068. Note that A/D circuit elements canalso be placed in the transducer probe housing.

The ultrasound probe 1040 includes subarray/apertures 1052 consisting ofneighboring elements with an aperture smaller than that of the wholearray. Returned echoes are received by the 1D transducer array 1062 andtransmitted to the controller 1044. The controller initiates formationof a coarse beam by transmitting the signals to memory 1058, 1046. Thememory 1058, 1046 transmits a signal to a transmit Driver 1 1050, andTransmit Driver m 1054. Transmit Driver 1 1050 and Transmit Driver m1054 then send the signal to mux 1 1048 and mux m 1056, respectively.The signal is transmitted to subarray beamformer 1 1052 and subarraybeamformer n 1060.

The outputs of each coarse beam forming operation then go through asecond stage beam forming in the interface unit 1020 to convert the beamforming output to digital representation. The coarse beamformingoperations are coherently summed to form a fine beam output for thearray. The signals are transmitted from the ultrasound probe 1040subarray beamformer 1 1052 and subarray beamformer n 1060 to the A/Dconvertors 1030 and 1028 within the host computer 1082. Within the hostcomputer 1082 there are A/D converters 1028, 1030 for converting thefirst stage beamforming output to digital representation. The digitalconversion is received from the A/D convertors 1030, 1028 by a customerASIC such as a FPGA 1026 to complete the second stage beamforming. TheFPGA Digital beamforming 1026 transmits information to the systemcontroller 1024. The system controller transmits information to a memory1032 which may send a signal back to the FPGA Digital Beam forming 1026.Alternatively, the system controller 1024 may transmit information tothe custom USB3 Chipset 1022. The USB3 Chipset 1022 may then transmitinformation to a DC-DC convertor 1034. In turn, the DC-DC convertor 1034may transmit power from the interface unit 1020 to the ultrasound probe1040. Within the ultrasound probe 1040 a power supply 1042 may receivethe power signal and interface with the transmit driver 1 1050 toprovide the power to the front end integration probe. The power supplycan include a battery to enable wireless operation of the transducerassembly. A wireless transceiver can be integrated into controllercircuit or a separate communications circuit to enable wireless transferof image data and control signals.

The host computer's 1082 custom or USB3 Chipset 1022 may be used toprovide a communication link between the custom or USB3 Chipset 1012 totransmits a signal to the microprocessor 1014. The microprocessor 1014then may display information or send information to a device 1075.

FIG. 11 is a detailed schematic block diagram of an exemplary embodimentof the ultrasound engine 108 (i.e., the front-end ultrasound specificcircuitry) and an exemplary embodiment of the computer motherboard 106(i.e., the host computer) of the ultrasound device illustrated in FIGS.1 and 2A. The components of the ultrasound engine 108 and/or thecomputer motherboard 106 may be implemented in application-specificintegrated circuits (ASICs). Exemplary ASICs have a high channel countand can pack 32 or more channels per chip in some exemplary embodiments.One of ordinary skill in the art will recognize that the ultrasoundengine 108 and the computer motherboard 106 may include more or fewermodules than those shown. For example, the ultrasound engine 108 and thecomputer motherboard 106 may include the modules shown in FIG. 17.

A transducer array 152 is configured to transmit ultrasound waves to andreceive reflected ultrasound waves from one or more image targets 1102.The transducer array 152 is coupled to the ultrasound engine 108 usingone or more cables 1104.

The ultrasound engine 108 includes a high-voltage transmit/receive (TR)module 1106 for applying drive signals to the transducer array 152 andfor receiving return echo signals from the transducer array 152. Theultrasound engine 108 includes a pre-amp/time gain compensation (TGC)module 1108 for amplifying the return echo signals and applying suitableTGC functions to the signals. The ultrasound engine 108 includes asampled-data beamformer 1110 that the delay coefficients used in eachchannel after the return echo signals have been amplified and processedby the pre-amp/TGC module 1108.

In some exemplary embodiments, the high-voltage TR module 1106, thepre-amp/TGC module 1108, and the sample-interpolate receive beamformer1110 may each be a silicon chip having 8 to 64 channels per chip, butexemplary embodiments are not limited to this range. In certainembodiments, the high-voltage TR module 1106, the pre-amp/TGC module1108, and the sample-interpolate receive beamformer 1110 may each be asilicon chip having 8, 16, 32, 64 channels, and the like. As illustratedin FIG. 11, an exemplary TR module 1106, an exemplary pre-amp/TGC module1108 and an exemplary beamformer 1110 may each take the form of asilicon chip including 32 channels.

The ultrasound engine 108 includes a first-in first-out (FIFO) buffermodule 1112 which is used for buffering the processed data output by thebeamformer 1110. The ultrasound engine 108 also includes a memory 1114for storing program instructions and data, and a system controller 1116for controlling the operations of the ultrasound engine modules.

The ultrasound engine 108 interfaces with the computer motherboard 106over a communications link 112 which can follow a standard high-speedcommunications protocol, such as the Fire Wire (IEEE 1394 StandardsSerial Interface) or fast (e.g., 200-400 Mbits/second or faster)Universal Serial Bus (USB 2.0 USB 3.0), protocol. The standardcommunication link to the computer motherboard operates at least at 400Mbits/second or higher, preferably at 800 Mbits/second or higher.Alternatively, the link 112 can be a wireless connection such as aninfrared (IR) link. The ultrasound engine 108 includes a communicationschipset 1118 (e.g., a Fire Wire chipset) to establish and maintain thecommunications link 112.

Similarly, the computer motherboard 106 also includes a communicationschipset 1120 (e.g., a Fire Wire chipset) to establish and maintain thecommunications link 112. The computer motherboard 106 includes a corecomputer-readable memory 1122 for storing data and/orcomputer-executable instructions for performing ultrasound imagingoperations. The memory 1122 forms the main memory for the computer and,in an exemplary embodiment, may store about 4 GB of DDR3 memory. Thecomputer motherboard 106 also includes a microprocessor 1124 forexecuting computer-executable instructions stored on the corecomputer-readable memory 1122 for performing ultrasound imagingprocessing operations. An exemplary microprocessor 1124 may be anoff-the-shelf commercial computer processor, such as an Intel Core-i5processor. Another exemplary microprocessor 1124 may be a digital signalprocessor (DSP) based processor, such as one or more DaVinci™ processorsfrom Texas Instruments. The computer motherboard 106 also includes adisplay controller 1126 for controlling a display device that may beused to display ultrasound data, scans and maps.

Exemplary operations performed by the microprocessor 1124 include, butare not limited to, down conversion (for generating I, Q samples fromreceived ultrasound data), scan conversion (for converting ultrasounddata into a display format of a display device), Doppler processing (fordetermining and/or imaging movement and/or flow information from theultrasound data), Color Flow processing (for generating, usingautocorrelation in one embodiment, a color-coded map of Doppler shiftssuperimposed on a B-mode ultrasound image), Power Doppler processing(for determining power Doppler data and/or generating a power Dopplermap), Spectral Doppler processing (for determining spectral Doppler dataand/or generating a spectral Doppler map), and post signal processing.These operations are described in further detail in WO 03/079038 A2,filed Mar. 11, 2003, titled “Ultrasound Probe with IntegratedElectronics,” the entire contents of which are expressly incorporatedherein by reference.

To achieve a smaller and lighter portable ultrasound devices, theultrasound engine 108 includes reduction in overall packaging size andfootprint of a circuit board providing the ultrasound engine 108. Tothis end, exemplary embodiments provide a small and light portableultrasound device that minimizes overall packaging size and footprintwhile providing a high channel count. In some embodiments, a highchannel count circuit board of an exemplary ultrasound engine mayinclude one or more multi-chip modules in which each chip providesmultiple channels, for example, 32 channels. The term “multi-chipmodule,” as used herein, refers to an electronic package in whichmultiple integrated circuits (IC) are packaged into a unifyingsubstrate, facilitating their use as a single component, i.e., as alarger IC. A multi-chip module may be used in an exemplary circuit boardto enable two or more active IC components integrated on a High DensityInterconnection (HDI) substrate to reduce the overall packaging size. Inan exemplary embodiment, a multi-chip module may be assembled byvertically stacking a transmit/receive (TR) silicon chip, an amplifiersilicon chip and a beamformer silicon chip of an ultrasound engine. Asingle circuit board of the ultrasound engine may include one or more ofthese multi-chip modules to provide a high channel count, whileminimizing the overall packaging size and footprint of the circuitboard.

FIG. 12 depicts a schematic side view of a portion of a circuit board1200 including a multi-chip module assembled in a vertically stackedconfiguration. Two or more layers of active electronic integratedcircuit components are integrated vertically into a single circuit. TheIC layers are oriented in spaced planes that extend substantiallyparallel to one another in a vertically stacked configuration. In FIG.12, the circuit board includes an HDI substrate 1202 for supporting themulti-chip module. A first integrated circuit chip 1204 including, forexample, a first beamformer device is coupled to the substrate 1202using any suitable coupling mechanism, for example, epoxy applicationand curing. A first spacer layer 1206 is coupled to the surface of thefirst integrated circuit chip 1204 opposite to the substrate 1202 using,for example, epoxy application and curing. A second integrated circuitchip 1208 having, for example, a second beamforer device is coupled tothe surface of the first spacer layer 1206 opposite to the firstintegrated circuit chip 1204 using, for example, epoxy application andcuring. A metal frame 1210 is provided for mechanical and/or electricalconnection among the integrated circuit chips. An exemplary metal frame1210 may take the form of a leadframe. The first integrated circuit chip1204 may be coupled to the metal frame 1210 using wiring 1212. Thesecond integrated circuit chip 1208 may be coupled to the same metalframe 1210 using wiring 1214. A packaging 1216 is provided toencapsulate the multi-chip module assembly and to maintain the multipleintegrated circuit chips in substantially parallel arrangement withrespect to one another.

As illustrated in FIG. 12, the vertical three-dimensional stacking ofthe first integrated circuit chip 1204, the first spacer layer 1206 andthe second integrated circuit chip 1208 provides high-densityfunctionality on the circuit board while minimizing overall packagingsize and footprint (as compared to an ultrasound engine circuit boardthat does not employ a vertically stacked multi-chip module). One ofordinary skill in the art will recognize that an exemplary multi-chipmodule is not limited to two stacked integrated circuit chips. Exemplarynumbers of chips vertically integrated in a multi-chip module mayinclude, but are not limited to, two, three, four, five, six, seven,eight, and the like.

In one embodiment of an ultrasound engine circuit board, a singlemulti-chip module as illustrated in FIG. 12 is provided. In otherembodiments, a plurality of multi-chip modules also illustrated in FIG.12. In an exemplary embodiment, a plurality of multi-chip modules (forexample, two multi-chip modules) may be stacked vertically on top of oneanother on a circuit board of an ultrasound engine to further minimizethe packaging size and footprint of the circuit board.

In addition to the need for reducing the footprint, there is also a needfor decreasing the overall package height in multi-chip modules.Exemplary embodiments may employ wafer thinning to sub-hundreds micronto reduce the package height in multi-chip modules.

Any suitable technique can be used to assemble a multi-chip module on asubstrate. Exemplary assembly techniques include, but are not limitedto, laminated MCM (MCM-L) in which the substrate is a multi-layerlaminated printed circuit board, deposited MCM (MCM-D) in which themulti-chip modules are deposited on the base substrate using thin filmtechnology, and ceramic substrate MCM (MCM-C) in which severalconductive layers are deposited on a ceramic substrate and embedded inglass layers that layers are co-fired at high temperatures (HTCC) or lowtemperatures (LTCC).

FIG. 13 is a flowchart of an exemplary method for fabricating a circuitboard including a multi-chip module assembled in a vertically stackedconfiguration. In step 1302, a HDI substrate is fabricated or provided.In step 1304, a metal frame (e.g., leadframe) is provided. In step 1306,a first IC layer is coupled or bonded to the substrate using, forexample, epoxy application and curing. The first IC layer is wire bondedto the metal frame. In step 1308, a spacer layer is coupled to the firstIC layer using, for example, epoxy application and curing, so that thelayers are stacked vertically and extend substantially parallel to eachother. In step 1310, a second IC layer is coupled to the spacer layerusing, for example, epoxy application and curing, so that all of thelayers are stacked vertically and extend substantially parallel to oneanother. The second IC layer is wire bonded to the metal frame. In step1312, a packaging is used to encapsulate the multi-chip module assembly.

Exemplary chip layers in a multi-chip module may be coupled to eachother using any suitable technique. For example, in the embodimentillustrated in FIG. 12, spacer layers may be provided between chiplayers to spacedly separate the chip layers. Passive silicon layers, dieattach paste layers and/or die attach film layers may be used as thespacer layers. Exemplary spacer techniques that may be used infabricating a multi-chip module is further described in Toh CH et al.,“Die Attach Adhesives for 3D Same-Sized Dies Stacked Packages,” the 58thElectronic Components and Technology Conference (ECTC2008), pp. 1538-43,Florida, US (27-30 May 2008), the entire contents of which are expresslyincorporated herein by reference.

Important requirements for the die attach (DA) paste or film isexcellent adhesion to the passivation materials of adjacent dies. Also,a uniform bond-link thickness (BLT) is required for a large dieapplication. In addition, high cohesive strength at high temperaturesand low moisture absorption are preferred for reliability.

FIGS. 14A-14C are schematic side views of exemplary multi-chip modules,including vertically stacked dies, that may be used in accordance withexemplary embodiments. Both peripheral and center pads wire bond (WB)packages are illustrated and may be used in wire bonding exemplary chiplayers in a multi-chip module. FIG. 14A is a schematic side view of amulti-chip module including four vertically stacked dies in which thedies are spacedly separated from one another by passive silicon layerswith a 2-in-1 dicing die attach film (D-DAF). FIG. 14B is a schematicside view of a multi-chip module including four vertically stacked diesin which the dies are spacedly separated from one another by DAfilm-based adhesives acting as die-to-die spacers. FIG. 14C is aschematic side view of a multi-chip module including four verticallystacked dies in which the dies are spacedly separated from one anotherby DA paste or film-based adhesives acting as die-to-die spacers. The DApaste or film-based adhesives may have wire penetrating capability insome exemplary embodiments. In the exemplary multi-chip module of FIG.14C, film-over wire (FOW) is used to allow long wire bonding and centerbond pads stacked die packages. FOW employs a die-attach film with wirepenetrating capability that allows the same or similar-sized wire-bondeddies to be stacked directly on top of one another without passivesilicon spacers. This solves the problem of stacking same orsimilar-sized dies directly on top of each other, which otherwise posesa challenge as there is no or insufficient clearance for the bond wiresof the lower dies.

The DA material illustrated in FIGS. 14B and 14C preferably maintain abond-line thickness (BLT) with little to no voiding and bleed outthrough the assembly process. Upon assembly, the DA materials sandwichedbetween the dies maintain an excellent adhesion to the dies. Thematerial properties of the DA materials are tailored to maintain highcohesive strength for high temperature reliability stressing withoutbulk fracture. The material properties of the DA materials are tailoredto also minimize or preferably eliminate moisture accumulation that maycause package reliability failures (e.g., popcorning whereby interfacialor bulk fractures occur as a result of pressure build-up from moisturein the package).

FIG. 15 is a flowchart of certain exemplary methods of die-to-diestacking using (a) passive silicon layers with a 2-in-1 dicing dieattach film (D-DAF), (b) DA paste, (c) thick DA-film, and (d) film-overwire (FOW) that employs a die-attach film with wire penetratingcapability that allows the same or similar-sized wire-bonded dies to bestacked directly on top of one another without passive silicon spacers.Each method performs backgrinding of wafers to reduce the waferthickness to enable stacking and high density packaging of integratedcircuits. The wafers are sawed to separate the individual dies. A firstdie is bonded to a substrate of a multi-chip module using, for example,epoxy application and curing in an oven. Wire bonding is used to couplethe first die to a metal frame.

In method (A), a first passive silicon layer is bonded to the first diein a stacked manner using a dicing die-attach film (D-DAF). A second dieis bonded to the first passive layer in a stacked manner using D-DAF.Wire bonding is used to couple the second die to the metal frame. Asecond passive silicon layer is bonded to the second die in a stackedmanner using D-DAF. A third die is bonded to the second passive layer ina stacked manner using D-DAF. Wire bonding is used to couple the thirddie to the metal frame. A third passive silicon layer is bonded to thethird die in a stacked manner using D-DAF. A fourth die is bonded to thethird passive layer in a stacked manner using D-DAF. Wire bonding isused to couple the fourth die to the metal frame.

In method (B), die attach (DA) paste dispensing and curing is repeatedfor multi-thin die stack application. DA paste is dispensed onto a firstdie, and a second die is provided on the DA paste and cured to the firstdie. Wire bonding is used to couple the second die to the metal frame.DA paste is dispensed onto the second die, and a third die is providedon the DA paste and cured to the second die. Wire bonding is used tocouple the third die to the metal frame. DA paste is dispensed onto thethird die, and a fourth die is provided on the DA paste and cured to thethird die. Wire bonding is used to couple the fourth die to the metalframe.

In method (C), die attach films (DAF) are cut and pressed to a bottomdie and a top die is then placed and thermal compressed onto the DAF.For example, a DAF is pressed to the first die and a second die isthermal compressed onto the DAF. Wire bonding is used to couple thesecond die to the metal frame. Similarly, a DAF is pressed to the seconddie and a third die is thermal compressed onto the DAF. Wire bonding isused to couple the third die to the metal frame. A DAF is pressed to thethird die and a fourth die is thermal compressed onto the DAF. Wirebonding is used to couple the fourth die to the metal frame.

In method (D), film-over wire (FOW) employs a die-attach film with wirepenetrating capability that allows the same or similar-sized wire-bondeddies to be stacked directly on top of one another without passivesilicon spacers. A second die is bonded and cured to the first die in astacked manner. Film-over wire bonding is used to couple the second dieto the metal frame. A third die is bonded and cured to the first die ina stacked manner. Film-over wire bonding is used to couple the third dieto the metal frame. A fourth die is bonded and cured to the first die ina stacked manner. Film-over wire bonding is used to couple the fourthdie to the metal frame.

After the above-described steps are completed, in each method (a)-(d),wafer molding and post-mold curing (PMC) are performed. Subsequently,ball mount and singulation are performed.

Further details on the above-described die attachment techniques areprovided in TOH CH et al., “Die Attach Adhesives for 3D Same-Sized DiesStacked Packages,” the 58th Electronic Components and TechnologyConference (ECTC2008), pp. 1538-43, Florida, US (27-30 May 2008), theentire contents of which are expressly incorporated herein by reference.

FIG. 16 is a schematic side view of a multi-chip module 1600 including aTR chip 1602, an amplifier chip 1604 and a beamformer chip 1606vertically integrated in a vertically stacked configuration on asubstrate 1614. Any suitable technique illustrated in FIGS. 12-15 may beused to fabricate the multi-chip module. One of ordinary skill in theart will recognize that the particular order in which the chips arestacked may be different in other embodiments. First and second spacerlayers 1608, 1610 are provided to spacedly separate the chips 1602,1604, 1606. Each chip is coupled to a metal frame (e.g., a leadframe)1612. In certain exemplary embodiments, heat transfer and heat sinkmechanisms may be provided in the multi-chip module to sustain hightemperature reliability stressing without bulk failure. Other componentsof FIG. 16 are described with reference to FIGS. 12 and 14.

In this exemplary embodiment, each multi-chip module may handle thecomplete transmit, receive, TGC amplification and beam formingoperations for a large number of channels, for example, 32 channels. Byvertically integrating the three silicon chips into a single multi-chipmodule, the space and footprint required for the printed circuit boardis further reduced. A plurality of multi-chip modules may be provided ona single ultrasound engine circuit board to further increase the numberof channels while minimizing the packaging size and footprint. Forexample, a 128 channel ultrasound engine circuit board 108 can befabricated within exemplary planar dimensions of about 10 cm× about 10cm, which is a significant improvement of the space requirements ofconventional ultrasound circuits. A single circuit board of anultrasound engine including one or more multi-chip modules may have 16to 128 channels in preferred embodiments. In certain embodiments, asingle circuit board of an ultrasound engine including one or moremulti-chip modules may have 16, 32, 64, 128 channels, and the like.

FIG. 17 is a detailed schematic block diagram of an exemplary embodimentof the ultrasound engine 108 (i.e., the front-end ultrasound specificcircuitry) and an exemplary embodiment of the computer motherboard 106(i.e., the host computer) provided as a single board complete ultrasoundsystem. An exemplary single board ultrasound system as illustrated inFIG. 17 may have exemplary planar dimensions of about 25 cm× about 18cm, although other dimensions are possible. The single board completeultrasound system of FIG. 17 may be implemented in the ultrasound deviceillustrated in FIGS. 1, 2A, 2B, and 9A, and may be used to perform theoperations depicted in FIGS. 3-8, 9B, and 10.

The ultrasound engine 108 includes a probe connector 114 to facilitatethe connection of at least one ultrasound probe/transducer. In theultrasound engine 108, a TR module, an amplifier module and a beamformermodule may be vertically stacked to form a multi-chip module as shown inFIG. 16, thereby minimizing the overall packaging size and footprint ofthe ultrasound engine 108. The ultrasound engine 108 may include a firstmulti-chip module 1710 and a second multi-chip module 1712, eachincluding a TR chip, an ultrasound pulser and receiver, an amplifierchip including a time-gain control amplifier, and a sample-databeamformer chip vertically integrated in a stacked configuration asshown in FIG. 16. The first and second multi-chip modules 1710, 1712 maybe stacked vertically on top of each other to further minimize the arearequired on the circuit board. Alternatively, the first and secondmulti-chip modules 1710, 1712 may be disposed horizontally on thecircuit board. In an exemplary embodiment, the TR chip, the amplifierchip and the beamformer chip is each a 32-channel chip, and eachmulti-chip module 1710, 1712 has 32 channels. One of ordinary skill inthe art will recognize that exemplary ultrasound engines 108 mayinclude, but are not limited to, one, two, three, four, five, six,seven, eight multi-chip modules. Note that in a preferred embodiment thesystem can be configured with a first beamformer in the transducerhousing and a second beamformer in the tablet housing.

The ASICs and the multi-chip module configuration enable a 128-channelcomplete ultrasound system to be implemented on a small single board ina size of a tablet computer format. An exemplary 128-channel ultrasoundengine 108, for example, can be accommodated within exemplary planardimensions of about 10 cm× about 10 cm, which is a significantimprovement of the space requirements of conventional ultrasoundcircuits. An exemplary 128-channel ultrasound engine 108 can also beaccommodated within an exemplary area of about 100 cm².

The ultrasound engine 108 also includes a clock generation complexprogrammable logic device (CPLD) 1714 for generating timing clocks forperforming an ultrasound scan using the transducer array. The ultrasoundengine 108 includes an analog-to-digital converter (ADC) 1716 forconverting analog ultrasound signals received from the transducer arrayto digital RF formed beams. The ultrasound engine 108 also includes oneor more delay profile and waveform generator field programmable gatearrays (FPGA) 1718 for managing the receive delay profiles andgenerating the transmit waveforms. The ultrasound engine 108 includes amemory 1720 for storing the delay profiles for ultrasound scanning. Anexemplary memory 1720 may be a single DDR3 memory chip. The ultrasoundengine 108 includes a scan sequence control field programmable gatearray (FPGA) 1722 configured to manage the ultrasound scan sequence,transmit/receiving timing, storing and fetching of profiles to/from thememory 1720, and buffering and moving of digital RF data streams to thecomputer motherboard 106 via a high-speed serial interface 112. Thehigh-speed serial interface 112 may include Fire Wire or other serial orparallel bus interface between the computer motherboard 106 and theultrasound engine 108. The ultrasound engine 108 includes acommunications chipset 1118 (e.g., a Fire Wire chipset) to establish andmaintain the communications link 112.

A power module 1724 is provided to supply power to the ultrasound engine108, manage a battery charging environment and perform power managementoperations. The power module 1724 may generate regulated, low noisepower for the ultrasound circuitry and may generate high voltages forthe ultrasound transmit pulser in the TR module.

The computer motherboard 106 includes a core computer-readable memory1122 for storing data and/or computer-executable instructions forperforming ultrasound imaging operations. The memory 1122 forms the mainmemory for the computer and, in an exemplary embodiment, may store about4 Gb of DDR3 memory. The memory 1122 may include a solid state harddrive (SSD) for storing an operating system, computer-executableinstructions, programs and image data. An exemplary SSD may have acapacity of about 128 GB.

The computer motherboard 106 also includes a microprocessor 1124 forexecuting computer-executable instructions stored on the corecomputer-readable memory 1122 for performing ultrasound imagingprocessing operations. Exemplary operations include, but are not limitedto, down conversion, scan conversion, Doppler processing, Color Flowprocessing, Power Doppler processing, Spectral Doppler processing, andpost signal processing. An exemplary microprocessor 1124 may be anoff-the-shelf commercial computer processor, such as an Intel Core-i5processor. Another exemplary microprocessor 1124 may be a digital signalprocessor (DSP) based processor, such as DaVinci™ processors from TexasInstruments.

The computer motherboard 106 includes an input/output (I/O) and graphicschipset 1704 which includes a co-processor configured to control I/O andgraphic peripherals such as USB ports, video display ports and the like.The computer motherboard 106 includes a wireless network adapter 1702configured to provide a wireless network connection. An exemplaryadapter 1702 supports 802.11g and 802.11n standards. The computermotherboard 106 includes a display controller 1126 configured tointerface the computer motherboard 106 to the display 104. The computermotherboard 106 includes a communications chipset 1120 (e.g., a FireWire chipset or interface) configured to provide a fast datacommunication between the computer motherboard 106 and the ultrasoundengine 108. An exemplary communications chipset 1120 may be an IEEE1394b 800 Mbit/sec interface. Other serial or parallel interfaces 1706may alternatively be provided, such as USB3, Thunder-Bolt, PCIe, and thelike. A power module 1708 is provided to supply power to the computermotherboard 106, manage a battery charging environment and perform powermanagement operations.

An exemplary computer motherboard 106 may be accommodated withinexemplary planar dimensions of about 12 cm× about 10 cm. An exemplarycomputer motherboard 106 can be accommodated within an exemplary area ofabout 120 cm².

FIG. 18 is a perspective view of an exemplary portable ultrasound system100 provided in accordance with exemplary embodiments. The system 100includes a housing 102 that is in a tablet form factor as illustrated inFIG. 18, but that may be in any other suitable form factor. An exemplaryhousing 102 may have a thickness below 2 cm and preferably between 0.5and 1.5 cm. A front panel of the housing 102 includes a multi-touch LCDtouch screen display 104 that is configured to recognize and distinguishone or more multiple and/or simultaneous touches on a surface of thetouch screen display 104. The surface of the display 104 may be touchedusing one or more of a user's fingers, a user's hand or an optionalstylus 1802. The housing 102 includes one or more I/O port connectors116 which may include, but are not limited to, one or more USBconnectors, one or more SD cards, one or more network mini displayports, and a DC power input. The embodiment of housing 102 in FIG. 18can also be configured within a palm-carried form factor havingdimensions of 150 mm×100 mm×15 mm (a volume of 225000 mm³) or less. Thehousing 102 can have a weight of less than 200 g. Optionally, cablingbetween the transducer array and the display housing can includeinterface circuitry 1020 as described herein. The interface circuitry1020 can include, for example, beamforming circuitry and/or A/Dcircuitry in a pod that dangles from the tablet. Separate connectors1025, 1027 can be used to connect the dangling pod to the transducerprobe cable. The connector 1027 can include probe identificationcircuitry as described herein. The unit 102 can include a camera, amicrophone and a speaker as well as wireless telephone circuitry forvoice and data communications as well as voice activated software thatcan be used to control the ultrasound imaging operations describedherein.

The housing 102 includes or is coupled to a probe connector 114 tofacilitate connection of at least one ultrasound probe/transducer 150.The ultrasound probe 150 includes a transducer housing including one ormore transducer arrays 152. The ultrasound probe 150 is couplable to theprobe connector 114 using a housing connector 1804 provided along aflexible cable 1806. One of ordinary skill in the art will recognizethat the ultrasound probe 150 may be coupled to the housing 102 usingany other suitable mechanism, for example, an interface housing thatincludes circuitry for performing ultrasound-specific operations likebeamforming. Other exemplary embodiments of ultrasound systems aredescribed in further detail in WO 03/079038 A2, filed Mar. 11, 2003,titled “Ultrasound Probe with Integrated Electronics,” the entirecontents of which is expressly incorporated herein by reference.Preferred embodiments can employ a wireless connection between thehand-held transducer probe 150 and the display housing. Beamformerelectronics can be incorporated into probe housing 150 to providebeamforming of subarrays in a 1D or 2D transducer array as describedherein. The display housing can be sized to be held in the palm of theuser's hand and can include wireless network connectivity to publicaccess networks such as the internet.

FIG. 19 illustrates an exemplary view of a main graphical user interface(GUI) 1900 rendered on the touch screen display 104 of the portableultrasound system 100 of FIG. 18. The main GUI 1900 may be displayedwhen the ultrasound system 100 is started. To assist a user innavigating the main GUI 1900, the GUI may be considered as includingfour exemplary work areas: a menu bar 1902, an image display window1904, an image control bar 1906, and a tool bar 1908. Additional GUIcomponents may be provided on the main GUI 1900 to, for example, enablea user to close, resize and exit the GUI and/or windows in the GUI.

The menu bar 1902 enables a user to select ultrasound data, imagesand/or videos for display in the image display window 1904. The menu bar1902 may include, for example, GUI components for selecting one or morefiles in a patient folder directory and an image folder directory. Theimage display window 1904 displays ultrasound data, images and/or videosand may, optionally, provide patient information. The tool bar 1908provides functionalities associated with an image or video displayincluding, but not limited to, a save button for saving the currentimage and/or video to a file, a save Loop button that saves a maximumallowed number of previous frames as a Cine loop, a print button forprinting the current image, a freeze image button for freezing an image,a playback toolbar for controlling aspects of playback of a Cine loop,and the like. Exemplary GUI functionalities that may be provided in themain GUI 1900 are described in further detail in WO 03/079038 A2, filedMar. 11, 2003, titled “Ultrasound Probe with Integrated Electronics,”the entire contents of which are expressly incorporated herein byreference.

The image control bar 1906 includes touch controls that may be operatedby touch and touch gestures applied by a user directly to the surface ofthe display 104. Exemplary touch controls may include, but are notlimited to, a 2D touch control 408, a gain touch control 410, a colortouch control 412, a storage touch control 414, a split touch control416, a PW imaging touch control 418, a beamsteering touch control 20, anannotation touch control 422, a dynamic range operations touch control424, a Teravision™ touch control 426, a map operations touch control428, and a needle guide touch control 428. These exemplary touchcontrols are described in further detail in connection with FIGS. 4 a-4c.

FIG. 20 depicts an illustrative embodiment of exemplary medicalultrasound imaging equipment 2000, implemented in the form factor of atablet in accordance with the invention. The table may have thedimensions of 12.5″×1.25″×8.75″ or 31.7 cm×3.175 cm×22.22 cm but it mayalso be in any other suitable form factor having a volume of less than2500 cm³ and a weight of less than 8 lbs. As shown in FIG. 20, themedical ultrasound imaging equipment 2000, includes a housing 2030, atouch screen display 2010, wherein ultrasound images 2010, and ultrasound data 2040, can be displayed and ultrasound controls 2020, areconfigured to be controlled by a touchscreen display 2010. The housing2030, may have a front panel 2060 and a rear panel 2070. The touchscreendisplay 2010, forms the front panel 2060, and includes a multi-touch LCDtouch screen that can recognize and distinguish one or more multiple andor simultaneous touches of the user on the touchscreen display 2010. Thetouchscreen display 2010 may have a capacitive multi-touch and AVAH LCDscreen. For example, the capacitive multi-touch and AVAH LCD screen mayenable a user to view the image from multi angles without losingresolution. In another embodiment, the user may utilize a stylus fordata input on the touch screen. The tablet can include an integratedfoldable stand that permits a user to swivel the stand from a storageposition that conforms to the tablet form factor so that the device canlay flat on the rear panel, or alternatively, the user can swivel thestand to enable the tablet to stand at an upright position at one of aplurality of oblique angles relative to a support surface.

Capacitive touchscreen module comprises an insulator for example glass,coated with a transparent conductor, such as indium tin oxide. Themanufacturing process may include a bonding process among glass,x-sensor film, y-sensor film and a liquid crystal material. The tabletis configured to allow a user to perform multi-touch gestures such aspinching and stretching while wearing a dry or a wet glove. The surfaceof the screen registers the electrical conductor making contact with thescreen. The contact distorts the screens electrostatic field resultingin measurable changes in capacitance. A processor then interprets thechange in the electrostatic field. Increasing levels of responsivenessare enabled by reducing the layers and by producing touch screens with“in-cell” technology. “In-cell” technology eliminates layers by placingthe capacitors inside the display. Applying “in-cell” technology reducesthe visible distance between the user's finger and the touchscreentarget, thereby creating a more directive contact with the contentdisplayed and enabling taps and gestures to have an increase inresponsiveness.

FIG. 21 illustrates a preferred cart system for a modular ultrasoundimaging system in accordance with the invention. The cart system 2100uses a base assembly 2122 including a docking bay that receives thetablet. The cart configuration 2100 is configured to dock tablet 2104,including a touch screen display 2102, to a cart 2108, which can includea full operator console 2124. After the tablet 2104, is docked to thecart stand 2108, the system forms a full feature roll about system. Thefull feature roll about system may include, an adjustable height device2106, a gel holder 2110, and a storage bin 2114, a plurality of wheels2116, a hot probe holder 2120, and the operator console 2124. Thecontrol devices may include a keyboard 2112 on the operator console 2124that may also have other peripherals added such as a printer or a videointerface or other control devices.

FIG. 22 illustrate a preferred cart system, for use in embodiments witha modular ultrasound imaging system in accordance with the invention.The cart system 2200 may be configured with a vertical support member2212, coupled to a horizontal support member 2028. An auxiliary deviceconnector 2018, having a position for auxiliary device attachment 2014,may be configured to connect to the vertical support member 2212. A 3port Probe MUX connection device 2016 may also be configured to connectto the tablet. A storage bin 2224 can be configured to attach by astorage bin attachment mechanism 2222, to vertical support member 2212.The cart system may also include a cord management system 2226,configured to attach to the vertical support member. The cart assembly2200 includes the support beam 2212 mounted on a base 2228 having wheels2232 and a battery 2230 that provides power for extended operation ofthe tablet. The assembly can also include an accessory holder 2224mounted with height adjustment device 2226. Holders 2210, 2218 can bemounted on beam 2212 or on console panel 2214. The multiport probemultiplex device 2216 connects to the tablet to provide simultaneousconnection of several transducer probes which the user can select insequence with the displayed virtual switch. A moving touch gesture, suchas a three finger flick on the displayed image or touching of adisplayed virtual button or icon can switch between connected probes.

FIG. 23 illustrates preferred cart mount system for a modular ultrasoundimaging system in accordance with the invention. Arrangement 2300depicts the tablet 2302, coupled to the docking station 2304. Thedocking station 2304 is affixed to the attachment mechanism 2306. Theattachment mechanism 2306 may include a hinged member 2308, allowing forthe user display to tilted into a user desired position. The attachmentmechanism 2306 is attached to the vertical member 2312. A tablet 2302 asdescribed herein can be mounted on the base docking unit 2304 which ismounted to a mount assembly 2306 on top of beam 2212. The base unit 2304includes cradle 2310, electrical connectors 2305 and a port 2307 toconnect to the system 2302 to battery 2230 and multiplexor device 2216.

FIG. 24 illustrates preferred cart system 2400 modular ultrasoundimaging system in accordance with the invention in which tablet 2402 isconnected on mounting assembly 2406 with connector 2404. Arrangement2400 depicts the tablet 2402, coupled to the vertical support member2408, via attachment mechanism 2404 without the docking element 2304.Attachment mechanism 2404 may include a hinged member 2406 for displayadjustment.

FIGS. 25A and 25B illustrate a multi-function docking station. FIG. 25Aillustrates docking station 2502, and tablet 2504, having a baseassembly 2506, that mates to the docking station 2502. The tablet 2504,and the docking station 2502, may be electrically connected. The tablet2504 may be released from docking station 2502, by engaging the releasemechanism 2508. The docking station 2502 may contain a transducer port2512, for connection of a transducer probe 2510. The docking station2502 can contain 3 USB 3.0 ports, a LAN port, a headphone jack and apower connector for charging. FIG. 25B illustrates a side view of thetablet 2504, and docking station 2502, having a stand in accordance withthe preferred embodiments of the present invention. The docking stationmay include an adjustable stand/handle 2526. The adjustable stand/handle2526 may be tilted for multiple viewing angles. The adjustablestand/handle 2526 may be flipped up for transport purposes. The sideview also illustrates a transducer port 2512, and a transducer probeconnector 2510.

FIG. 26 illustrates a 2D imaging mode of operation with a modularultrasound imaging system in accordance with the invention. The touchscreen of table 2504 may display images obtained by 2-dimensionaltransducer probe using a 256 digital beamformer channels. The2-dimensional image window 2602 depicts a 2-dimensional image scan 2604.The 2-dimensional image may be obtained using flexible frequency scans2606, wherein the control parameters are represented on the tablet.

FIG. 27 illustrates a motion mode of operation with a modular ultrasoundimaging system in accordance with the invention. The touch screendisplay of tablet 2700, may display images obtained by a motion mode ofoperation. The touch screen display of tablet 2700, may simultaneouslydisplay 2-dimensional 2706, and motion mode imaging 2708. The touchscreen display of tablet 2700, may display a 2-dimensional image window2704, with a 2-dimensional image 2706. Flexible frequency controls 2702displayed with the graphical user interface can be used to adjust thefrequency from 2 MHz to 12 MHz.

FIG. 28 illustrates a color Doppler mode of operation with a modularultrasound imaging system in accordance with the invention. The touchscreen display of tablet 2800 displays images obtained by color Dopplermode of operation. A 2-dimensional image window 2806 is used as the basedisplay. The color coded information 2808, is overlaid on the2-dimensional image 2810. Ultrasound-based imaging of red blood cellsare derived from the received echo of the transmitted signal. Theprimary characteristics of the echo signal are the frequency and theamplitude. Amplitude depends on the amount of moving blood within thevolume sampled by the ultrasound beam. A high frame rate or highresolution can be adjusted with the display to control the quality ofthe scan. Higher frequencies may be generated by rapid flow and can bedisplayed in lighter colors, while lower frequencies are displayed indarker colors. Flexible frequency controls 2804, and color Doppler scaninformation 2802, may be displayed on the tablet display 2800.

FIG. 29 illustrates a Pulsed wave Doppler mode of operation with amodular ultrasound imaging system in accordance with the invention. Thetouch screen display of tablet 2900, may display images obtained bypulsed wave Doppler mode of operation. Pulsed wave Doppler scans producea series of pulses used to analyse the motion of blood flow in a smallregion along a desired ultrasound cursor called the sample volume orsample gate 2012. The tablet display 2900 may depict a 2-dimensionalimage 2902, wherein the sample volume/sample gate 2012 is overlaid. Thetablet display 2900 may use a mixed mode of operation 2906, to depict a2-dimensional image 2902, and a time/doppler frequency shift 2910. Thetime/doppler frequency shift 2910 can be converted into velocity andflow if an appropriate angle between the beam and blood flow is known.Shades of gray 2908, in the time/doppler frequency shift 2910, mayrepresent the strength of signal. The thickness of the spectral signalmay be indicative of laminar or turbulent flow. The tablet display 2900can depict adjustable frequency controls 2904.

FIG. 30 illustrates a triplex scan mode of operation with a modularultrasound imaging system in accordance with the invention. The tabletdisplay 3000 may include a 2-dimensional window 3002, capable ofdisplaying 2-dimensional images alone or in combination with the colorDoppler or directional Doppler features. The touch screen display oftablet 3000, may display images obtained by color Doppler mode ofoperation. A 2-dimensional image window 3002 is used as the basedisplay. The color coded information 3004, is overlaid 3006, on the2-dimensional image 3016. The pulsed wave Doppler feature may be usedalone or in combination with 2-dimensional imaging or the color Dopplerimaging. The tablet display 3000 may include a pulsed wave Doppler scanrepresented by a sample volume/sample gate 3008, overlaid over 2dimensional images 3016, or the color code overlaid 3006, either aloneor in combination. The tablet display 3000 may depict a split screenrepresenting the time/doppler frequency shift 3012. The time/dopplerfrequency shift 3012 can be converted into velocity and flow if anappropriate angle between the insolating beam and blood flow is known.Shades of gray 3014, in the time/doppler frequency shift 3012, mayrepresent the strength of signal. The thickness of the spectral signalmay be indicative of laminar or turbulent flow. The tablet display 3000also may depict flexible frequency controls 3010.

FIG. 31 illustrates a GUI home screen interface 3100, for a user mode ofoperation, with a modular ultrasound imaging system in accordance withthe invention. The screen interface for a user mode of operation 3100may be displayed when the ultrasound system is started. To assist a userin navigating the GUI home screen 3100, the home screen may beconsidered as including three exemplary work areas: a menu bar 3104, animage display window 3102, and an image control bar 3106. Additional GUIcomponents may be provided on the main GUI home screen 3100, to enable auser to close, resize and exit the GUI home screen and/or windows in theGUI home screen.

The menu bar 3104 enables users to select ultrasound data, images and/orvideo for display in the image display window 3102. The menu bar mayinclude components for selecting one or more files in a patient folderdirectly and an image folder directory.

The image control bar 3106 includes touch controls that may be operatedby touch and touch gestures applied by the user directly to the surfaceof the display. Exemplary touch controls may include, but are notlimited to a depth control touch controls 3108, a 2-dimensional gaintouch control 3110, a full screen touch control 3112, a text touchcontrol 3114, a split screen touch control 3116, a ENV touch control3118, a CD touch control 3120, a PWD touch control 3122, a freeze touchcontrol 3124, a store touch control 3126, and a optimize touch control3128.

FIG. 32 illustrates a GUI menu screen interface 3200, for a user mode ofoperation, with a modular ultrasound imaging system in accordance withthe invention. The screen interface for a user mode of operation 3200may be displayed when the menu selection mode is triggered from the menubar 3204 thereby initiating operation of the ultrasound system. Toassist a user in navigating the GUI home screen 3100, the home screenmay be considered as including three exemplary work areas: a menu bar3204, an image display window 3202, and an image control bar 3220.Additional GUI components may be provided on the main GUI menu screen3200 to enable a user to close, resize and exit the GUI menu screenand/or windows in the GUI menu screen, for example.

The menu bar 3204 enables users to select ultra sound data, imagesand/or video for display in the image display window 3202. The menu bar3204 may include touch control components for selecting one or morefiles in a patient folder directory and an image folder directory.Depicted in an expanded format, the menu bar may include exemplary touchcontrol such as, a patient touch control 3208, a pre-sets touch control3210, a review touch control 3212, a report touch control 3214, and asetup touch control 3216.

The image control bar 3220 includes touch controls that may be operatedby touch and touch gestures applied by the user directly to the surfaceof the display. Exemplary touch controls may include, but are notlimited to depth control touch controls 3222, a 2-dimensional gain touchcontrol 3224, a full screen touch control 3226, a text touch control3228, a split screen touch control 3230, a needle visualization ENVtouch control 3232, a CD touch control 3234, a PWD touch control 3236, afreeze touch control 3238, a store touch control 3240, and a optimizetouch control 3242.

FIG. 33 illustrates a GUI patient data screen interface 3300, for a usermode of operation, with a modular ultrasound imaging system inaccordance with the invention. The screen interface for a user mode ofoperation 3300, may be displayed when the patient selection mode istriggered from the menu bar 3302, when the ultrasound system is started.To assist a user in navigating the GUI patient data screen 3300, thepatient data screen may be considered as including five exemplary workareas: a new patient touch screen control 3304, a new study touch screencontrol 3306, a study list touch screen control 3308, a work list touchscreen control 3310, and an edit touch screen control 3312. Within eachtouch screen control, further information entry fields are available3314, 3316. For example, patient information section 3314, and studyinformation section 3316, may be used to record data.

Within the patient data screen 3300, the image control bar 3318,includes touch controls that may be operated by touch and touch gesturesapplied by the user directly to the surface of the display. Exemplarytouch controls may include, but are not limited to accept study touchcontrol 3320, close study touch control 3322, print touch control 3324,print preview touch control 3326, cancel touch control 3328, a2-dimensional touch control 3330, freeze touch control 3332, and a storetouch control 3334.

FIG. 34 illustrates a GUI patient data screen interface 3400, for a usermode of operation with a modular ultrasound imaging system in accordancewith the invention. The screen interface for a user mode of operation3400, may be displayed when the pre-sets selection mode 3404, istriggered from the menu bar 3402, when the ultrasound system is started.

Within the pre-sets screen 3400, the image control bar 3408, includestouch controls that may be operated by touch and touch gestures appliedby the user directly to the surface of the display. Exemplary touchcontrols may include, but are not limited to a save settings touchcontrol 3410, a delete touch control 3412, CD touch control 3414, PWDtouch control 3416, a freeze touch control 3418, a store touch control3420, and a optimize touch control 3422.

FIG. 35 illustrates a GUI review screen interface 3500, for a user modeof operation, with a modular ultrasound imaging system in accordancewith the invention. The screen interface for a user mode of operation3500, may be displayed when the pre-sets expanded review 3504, selectionmode 3404, is triggered from the menu bar 3502, when the ultrasoundsystem is started.

Within the review screen 3500, the image control bar 3516, includestouch controls that may be operated by touch and touch gestures appliedby the user directly to the surface of the display. Exemplary touchcontrols may include, but are not limited to a thumbnail settings touchcontrol 3518, sync touch control 3520, selection touch control 3522, aprevious image touch control 3524, a next image touch control 3526, a2-dimensional image touch control 3528, a pause image touch control3530, and a store image touch control 3532.

A image display window 3506, may allow the user to review images in aplurality of formats. Image display window 3506, may allow a user toview images 3508, 3510, 3512, 3514, in combination or subset or allowany image 3508, 3510, 3512, 3514, to be viewed individually. The imagedisplay window 3506, may be configured to display up to four images3508, 3510, 3512, 3514, to be viewed simultaneously.

FIG. 36 illustrates a GUI Report Screen Interface for a user mode ofoperation with a modular ultrasound imaging system in accordance withthe invention. The screen interface for a user mode of operation 3600,may be displayed when the report expanded review 3604, is triggered fromthe menu bar 3602, when the ultrasound system is started. The displayscreen 3606, contains the ultrasound report information 3626. The usermay use the worksheet section within the ultrasound report 3626, toenter in comments, patient information and study information.

Within the report screen 3600, the image control bar 3608, includestouch controls that may be operated by touch and touch gestures appliedby the user directly to the surface of the display. Exemplary touchcontrols may include, but are not limited to a save touch control 3610,a save as touch control 3612, a print touch control 3614, a printpreview touch control 3616, a close study touch control 3618, a2-dimensional image touch control 3620, a freeze image touch control3622, and a store image touch control 3624.

FIG. 37 illustrates a GUI Setup Screen Interface for a user mode ofoperation with a modular ultrasound imaging system in accordance withthe invention. The screen interface for a user mode of operation 3700,may be displayed when the report expanded review 3704, is triggered fromthe menu bar 3702, when the ultrasound system is started.

Within the setup expanded screen 3704, the setup control bar 3744,includes touch controls that may be operated by touch and touchgestures, applied by the user directly to the surface of the display.Exemplary touch controls may include, but are not limited to a generaltouch control 3706, a display touch control 3708, a measurements touchcontrol 3710, annotation touch control 3712, a print touch control 3714,a store/acquire touch control 3716, a DICOM touch control 3718, anexport touch control 3720, and a study information image touch control3722. The touch controls may contain a display screen that allow theuser to enter configuration information. For example, the general touchcontrol 3706, contains a configuration screen 3724, wherein the user mayenter configuration information. Additionally, the general touch control3706, contains a section allowing user configuration of the soft keydocking position 3726. FIG. 37B depicts the soft key controls 3752, witha right side alignment. FIG. 37B further illustrates that activation ofthe soft key control arrow 3750, will change the key alignment to theopposite side, in this case, left side alignment. FIG. 37C depicts leftside alignment of the soft key controls 3762, the user may activate anorientation change by using the soft key control arrow 3760, to changethe position to right side alignment.

Within the review screen 3700, the image control bar 3728, includestouch controls that may be operated by touch and touch gestures appliedby the user directly to the surface of the display. Exemplary touchcontrols may include but are not limited to, a thumbnail settings touchcontrol 3730, sync touch control 3732, selection touch control 3734, aprevious image touch control 3736, a next image touch control 3738, a2-dimensional image touch control 3740, and a pause image touch control3742.

FIG. 38 illustrates a GUI Setup Screen Interface for a user mode ofoperation with a modular ultrasound imaging system in accordance withthe invention. The screen interface for a user mode of operation 3800,may be displayed when the report expanded review 3804, is triggered fromthe menu bar 3802, when the ultrasound system is started.

Within the setup expanded screen 3804, the setup control bar 3844,includes touch controls that may be operated by touch and touch gesturesapplied by the user directly to the surface of the display. Exemplarytouch controls may include, but are not limited to a plurality of iconssuch as a general touch control 3806, a display touch control 3808, ameasurements touch control 3810, annotation touch control 3812, a printtouch control 3814, a store/acquire touch control 3816, a DICOM touchcontrol 3818, an export touch control 3820, and a study informationimage touch control 3822. The touch controls can contain a displayscreen that allow the user to enter store/acquire information. Forexample, the store/acquire touch control 3816, contains a configurationscreen 3802, wherein the user may enter configuration information. Theuser can actuate a virtual keyboard allowing the user to enteralphanumeric characters in different touch activated fields.Additionally, the store/acquire touch control 3802, contains a sectionallowing user enablement of retrospective acquisition 3804. When theuser enables the store function, the system is defaulted to storeprospective cine loops. If the user enables the enable retrospectivecapture, the store function may collect the cine loop retrospectively.

Within the setup screen 3800, the image control bar 3828, includes touchcontrols that may be operated by touch and touch gestures applied by theuser directly to the surface of the display. Exemplary touch controlsmay include, but are not limited to a thumbnail settings touch control3830, synchronize touch control 3832, selection touch control 3834, aprevious image touch control 3836, a next image touch control 3838, a2-dimensional image touch control 3840, and a pause image touch control3842.

FIGS. 39A and 39B illustrate an XY bi-plane probe consisting of two onedimensional, multi-element arrays. The arrays may be constructed whereone array is on top of the other with a polarization axis of each arraybeing aligned in the same direction. The elevation axis of the twoarrays can be at a right angle or orthogonal to one another. Exemplaryembodiments can employ transducer assemblies such as those described inU.S. Pat. No. 7,066,887, the entire contents of which is incorporatedherein by reference, or transducers sold by Vernon of Tours Cedex,France, for example. Illustrated by FIG. 39A, the array orientation isrepresented by arrangement 3900. The polarization axis 3908, of botharrays are pointed in the z-axis 3906. The elevation axis of the bottomarray, is pointed in y-direction 3902, and the elevation axis of the toparray, is in the x-direction 3904.

Further illustrated by FIG. 39B, a one dimensional multi-element arrayforms an image as depicted in arrangement 3912. A one-dimensional arraywith an elevation axis 3910, in a y-direction 3914, forms the ultrasoundimage 3914, on the x-axis 3904, z-axis 3906, plane. A one-dimensionalarray with the elevation axis 3910, in the x-direction 3904, forms theultrasound image 3914, on the y-axis 3902, z-axis 3906. A onedimensional transducer array with elevation axis 3910, along a y-axis3902, and polarization axis 3908, along a z-axis 3906, will result in aultrasound image 3914, formed along the x 3904 and the z 3906 plane. Analternate embodiment illustrated by FIG. 39C depicts a one-dimensionaltransducer array with an elevation axis 3920, in a x-axis 904, and apolarization axis 3922, in the z-axis 3906, direction. The ultrasoundimage 3924, is formed on the y 3902 and the z 3906 plane.

FIG. 40 illustrates the operation of a bi-plane image forming xy-probewhere array 4012 has a high voltage applied for forming images. Highvoltage driving pulses 4006, 4008, 4010, may be applied to the bottomarray 4004, with a y-axis elevation. This application may result ingeneration of transmission pulses for forming the received image on theXZ plane, while keeping the elements of the top array 4002 at a groundedlevel. Such probes enable a 3D imaging mode using simpler electronicsthan a full 2D transducer array. A touchscreen activated user interfaceas described herein can employ screen icons and gestures to actuate 3Dimaging operations. Such imaging operations can be augmented by softwarerunning on the tablet data processor that processes the image data into3D ultrasound images. This image processing software can employfiltering smoothing and/or interpolation operations known in the art.Beamsteering can also be used to enable 3D imaging operations. Apreferred embodiment uses a plurality of 1D sub-array transducersarranged for bi plane imaging.

FIG. 41 illustrates the operation of a bi-plane image forming xy-probe.FIG. 41 illustrates a array 4110, that has a high voltage applied to itfor forming images. High voltage pulses 4102, 4104, 4106, may be appliedto the top array 4112, with elevation in the x-axis, generatingtransmission pulses for forming the received image on the yz-plane,while keeping the elements of the bottom array 4014, grounded 4108. Thisembodiment can also utilize orthogonal 1D transducer arrays operatedusing sub-array beamforming as described herein.

FIG. 42 illustrates the circuit requirements of a bi-plane image formingxy-probe. The receive beamforming requirements are depicted for abi-plane probe. A connection to receive the electronics 4202, is made.Then elements from the select bottom array 4204, and select top array4208, are connected to share one connect to the receive electronics 4202channel. A two to one mux circuit can be integrated on the high voltagedriver 4206, 4210. The two to one multiplexor circuit can be integratedinto high voltage driver 4206, 4212. One receive beam is formed for eachtransmit beam. The bi-plane system requires a total of 256 transmitbeams for which 128 transmit beams are used for forming a XZ-plane imageand the other 128 transmit beams are used for forming a YZ-plane image.A multiple-received beam forming technique can be used to improve theframe rate. An ultrasound system with dual received beam capabilitiesfor each transmit beam provides a system in which two received beams canbe formed. The bi-plane probe only needs a total of 128 transmit beamsfor forming the two orthogonal plane images, in which 64 transmit beamsare used to form a XZ-plane image with the other 64 transmit beams forthe YZ-plane image. Similarly, for an ultrasound system with a quad or 4receive beam capability, the probe requires 64 transmit beams to formtwo orthogonal-plane images.

FIGS. 43A-43B illustrate an application for simultaneous bi-planeevaluation. The ability to measure the LV mechanical dyssynchrony withechocardiograph can help identify patients that are more likely tobenefit from Cardiac Resynchronization Therapy. LV parameters needed tobe quantified are Ts-(lateral-septal), Ts-SD, Ts-peak, etc. TheTs-(lateral-septal) can be measured on a 2D apical 4-chamber view Echoimage, while the Ts-SD, Ts-peak (medial), Ts-onset (medial),Ts-peak(basal), Ts-onset (basal) can be obtained on two separatedparasternal short-axis views with 6 segments at the level of mitralvalve and at the papillary muscle level, respectively, providing a totalof 12 segments. FIG. 43A-43B depicts an xy-probe providing apical fourchamber 4304, and apicial two chamber 4302 images, to be viewedsimultaneously.

FIGS. 44A-44B illustrate ejection fraction probe measurement techniques.The biplane-probe provides for EF measurement, as visualization of twoorthogonal planes ensure on-axis views are obtained. Auto-borderdetection algorithm, provides quantitative Echo results to selectimplant responders and guide the AV delay parameter setting. As depictedin FIG. 44 A XY probe acquires real-time simultaneous images from twoorthogonal planes and the images 4402, 4404 are displayed on a splitscreen. A manual contour tracing or automatic boarder tracing techniquecan be used to trace the endocardial boarder at both end-systole andend-diastolic time from which the EF is calculated. The LV areas in theapical 2CH 4402, and 4CH 4404, views, A1 and A2 respectively, aremeasured at the end of diastole and the end of systole. The LVEDV, leftventricular end-diastolic volume, and LVESV, left ventricular theend-systole volume, are calculated using the formula:

$V = {\frac{8}{3\pi}{\frac{A_{1}A_{2}}{L}.}}$

And the ejection fraction is calculated by

${EF} = {\frac{{LVEDV} - {LVESD}}{LVEDV}.}$

It is noted that the operations described herein are purely exemplary,and imply no particular order. Further, the operations can be used inany sequence, when appropriate, and/or can be partially used. Exemplaryflowcharts are provided herein for illustrative purposes and arenon-limiting examples of methods. One of ordinary skill in the art willrecognize that exemplary methods may include more or fewer steps thanthose illustrated in the exemplary flowcharts, and that the steps in theexemplary flowcharts may be performed in a different order than shown.

In describing exemplary embodiments, specific terminology is used forthe sake of clarity. For purposes of description, each specific term isintended to at least include all technical and functional equivalentsthat operate in a similar manner to accomplish a similar purpose.Additionally, in some instances where a particular exemplary embodimentincludes a plurality of system elements or method steps, those elementsor steps may be replaced with a single element or step. Likewise, asingle element or step may be replaced with a plurality of elements orsteps that serve the same purpose. Further, where parameters for variousproperties are specified herein for exemplary embodiments, thoseparameters may be adjusted up or down by 1/20th, 1/10th, ⅕th, ⅓rd, ½,etc., or by rounded-off approximations thereof, unless otherwisespecified.

With the above illustrative embodiments in mind, it should be understoodthat such embodiments can employ various computer-implemented operationsinvolving data transferred or stored in computer systems. Suchoperations are those requiring physical manipulation of physicalquantities. Typically, though not necessarily, such quantities take theform of electrical, magnetic, and/or optical signals capable of beingstored, transferred, combined, compared, and/or otherwise manipulated.

Further, any of the operations described herein that form part of theillustrative embodiments are useful machine operations. The illustrativeembodiments also relate to a device or an apparatus for performing suchoperations. The apparatus can be specially constructed for the requiredpurpose, or can incorporate general-purpose computer devices selectivelyactivated or configured by a computer program stored in the computer. Inparticular, various general-purpose machines employing one or moreprocessors coupled to one or more computer readable media can be usedwith computer programs written in accordance with the teachingsdisclosed herein, or it may be more convenient to construct a morespecialized apparatus to perform the required operations.

The foregoing description has been directed to particular illustrativeembodiments of this disclosure. It will be apparent, however, that othervariations and modifications may be made to the described embodiments,with the attainment of some or all of their associated advantages.Moreover, the procedures, processes, and/or modules described herein maybe implemented in hardware, software, embodied as a computer-readablemedium having program instructions, firmware, or a combination thereof.For example, one or more of the functions described herein may beperformed by a processor executing program instructions out of a memoryor other storage device.

It will be appreciated by those skilled in the art that modifications toand variations of the above-described systems and methods may be madewithout departing from the inventive concepts disclosed herein.Accordingly, the disclosure should not be viewed as limited except as bythe scope and spirit of the appended claims.

1. A handheld medical ultrasound imaging device comprising: a transducerprobe housing a transducer array; and a tablet housing, the housinghaving a front panel, a computer in the housing, the computer includingat least one processor and at least one memory, a touch screen displaythat displays an ultrasound image, the touch screen display positionedon the front panel, and an ultrasound beamformer processing circuitdisposed in the housing that receives image data from the transducerarray, the touch screen display and the ultrasound beamformer processingcircuit being communicably connected to the computer, the computer beingoperative in response to a first gesture input from the touch screendisplay to alter an operation of the ultrasound beamformer processingcircuit.
 2. The device of claim 1 wherein the first gesture inputcorresponds to a moving gesture on the touch screen display.
 3. Thedevice of claim 1 wherein the transducer array comprises a bi planetransducer array.
 4. The device of claim 3 further comprising a secondinput that includes a double tap gesture against the touch screendisplay.
 5. The device of claim 3 further comprising in response to thesecond input from the touch screen display, displaying a first cursorinside a region of a virtual window displaying a magnified image.
 6. Thedevice of claim 5 further comprising receiving, at the computer, a thirdinput from the touch screen display, the third input being receivedinside the region of the virtual window.
 7. The device of claim 6wherein the third input corresponds to a drag gesture on the touchscreen display.
 8. The device of claim 6 further comprising in responseto the third input from the touch screen display, moving the firstcursor to a first location inside the region of the virtual window. 9.The device of claim 8 further comprising receiving, at the computer, afourth input from the touchscreen display, the fourth input beingreceived at the first location inside the region of the virtual window.10. The device of claim 1 wherein a fourth input corresponds to a pressgesture against the touch screen display.
 11. The device of claim 10further comprising receiving, at the computer, a second further inputfrom the touchscreen display, the second further input being receivedsubstantially simultaneously with the further input.
 12. The device ofclaim 11 wherein the transducer array comprises a plurality oftransducer arrays operated by a probe beamformer processing circuit. 13.The device of claim 11 further comprising in response to the secondfurther input from the touch screen display, fixing the first cursor atthe first location inside the region of the virtual window.
 14. Thedevice of claim 13 further comprising performing, by the computer, atleast one measurement on the ultrasound image based at least in part onthe first cursor at the first location.
 15. The device of claim 13further comprising receiving, at the computer, a third further inputfrom the touchscreen display.
 16. The device of claim 15 wherein thethird further input corresponds to a double tap gesture against thetouchscreen display.
 17. The device of claim 15 further comprising inresponse to the third further input from the touch screen display,displaying a second cursor at a second location inside the region of thevirtual window.
 18. The device of claim 17 wherein the computerprocesses at least one measurement with the ultrasound image based atleast in part on the respective locations of the first and secondcursors inside the region of the virtual window.
 19. The device of claim13 wherein the computer receives a fourth further input from thetouchscreen display, the fourth further input being received inside theregion of the virtual window.
 20. The device of claim 19 wherein thefourth further input corresponds to a press and drag gesture against thetouch screen display.
 21. The device of claim 19 further comprising inresponse to the fourth further input from the touch screen displayconnecting a line on the touch screen display extending from the firstcursor across at least a portion of the ultrasound image to a secondlocation inside the region of the virtual window.
 22. The device ofclaim 19 further comprising receiving, at the computer, an fifth inputfrom the touchscreen display.
 23. The device of claim 22 wherein thefifth input corresponds to a tap gesture against the touch screendisplay.
 24. The device of claim 22 further comprising in response tothe fifth input from the touch screen display, displaying a secondcursor inside the region of the virtual window, and fixing the secondcursor at the second location inside the region of the virtual window.25. The device of claim 24 further comprising a measurement on theultrasound image based at least in part on the connecting line extendingbetween the respective locations of the first and second cursors insidethe region of the virtual window.
 26. The device of claim 1 furthercomprising a transducer array connected to the housing with a transducerconnector.
 27. The device of claim 1 wherein the wherein the housing hasa volume of less than 2500 cubic centimeters.
 28. The device of claim 1wherein the housing is connected to a stand.
 29. The device of claim 28wherein the stand rotates relative to the housing.
 30. The device ofclaim 1 wherein the housing mounts on a cart.
 31. The device of claim 1wherein a multiplexor on the cart can electrically connect to thehousing to connect to a plurality of transducer arrays.
 32. The deviceof claim 28 wherein the housing docks with the stand.
 33. The device ofclaim 32 wherein the stand housing is electrically connected to thestand and wherein the stand has external communication parts.
 34. Thedevice of claim 31 wherein the multiplexor can be switched using a touchgesture.
 35. A method of operating a handheld medical ultrasound imagingdevice, the medical ultrasound imaging device comprising a transducerprobe, a tablet housing, the housing having a front panel, a computer inthe housing, the computer including at least one processor and at leastone memory, a touch screen display for displaying an ultrasound image,the touch screen display positioned on the front panel, and a secondultrasound beamformer processing circuit disposed in the housing, thetouch screen display and the ultrasound beamformer processing circuitbeing communicably coupled to the computer, the method comprising thesteps of: receiving, at the computer, a first gesture input from thetouch screen display; and in response to the first gesture input fromthe touch screen display, altering an operation of the ultrasoundbeamformer processing circuit.
 36. The method of claim 35 wherein thefirst gesture input corresponds to a moving gesture on the touch screendisplay.
 37. The method of claim 35 further comprising receiving, at thecomputer, a second input from the touch screen display.
 38. The methodof claim 37 wherein the second input corresponds to a double tap gestureagainst the touch screen display.
 39. The method of claim 37 furthercomprising in response to the second input from the touch screendisplay, displaying a first cursor inside a region of a virtual windowdisplaying a magnified image.
 40. The method of claim 39 furthercomprising receiving, at the computer, a third input from the touchscreen display, the third input being received inside the region of thevirtual window.
 41. The method of claim 40 wherein the third inputcorresponds to a drag gesture on the touch screen display.
 42. Themethod of claim 40 further comprising in response to the third inputfrom the touch screen display, moving the first cursor to a firstlocation inside the region of the virtual window.
 43. The method ofclaim 42 further comprising receiving, at the computer, a fourth inputfrom the touchscreen display, the fourth input being received at thefirst location inside the region of the virtual window.
 44. The methodof claim 35 wherein a fourth input corresponds to a press gestureagainst the touch screen display.
 45. The method of claim 44 furthercomprising receiving, at the computer, a second further input from thetouchscreen display, the second further input being receivedsubstantially simultaneously with the further input.
 46. The method ofclaim 44 wherein the second further input corresponds to a tap gestureagainst the touchscreen display.
 47. The method of claim 45 furthercomprising in response to the second further input from the touch screendisplay, fixing the first cursor at the first location inside the regionof the virtual window.
 48. The method of claim 47 further comprisingperforming, by the computer, at least one measurement on the ultrasoundimage based at least in part on the first cursor at the first location.49. The method of claim 47 further comprising receiving, at thecomputer, a third further input from the touchscreen display.
 50. Themethod of claim 49 wherein the third further input corresponds to adouble tap gesture against the touchscreen display.
 51. The method ofclaim 49 further comprising in response to the third further input fromthe touch screen display, displaying a second cursor at a secondlocation inside the region of the virtual window.
 52. The method ofclaim 51 further comprising performing, by the computer, at least onemeasurement on the ultrasound image based at least in part on therespective locations of the first and second cursors inside the regionof the virtual window.
 53. The method of claim 47 further comprisingreceiving, at the computer, a fourth further input from the touchscreendisplay, the fourth further input being received inside the region ofthe virtual window.
 54. The method of claim 53 wherein the fourthfurther input corresponds to a press and drag gesture against the touchscreen display.
 55. The method of claim 53 further comprising inresponse to the fourth further input from the touch screen display,providing a connecting line on the touch screen display extending fromthe first cursor across at least a portion of the ultrasound image to asecond location inside the region of the virtual window.
 56. The methodof claim 53 further comprising receiving, at the computer, an fifthinput from the touchscreen display.
 57. The method of claim 56 whereinthe fifth input corresponds to a tap gesture against the touch screendisplay.
 58. The method of claim 56 further comprising in response tothe fifth input from the touch screen display, displaying a secondcursor inside the region of the virtual window, and fixing the secondcursor at the second location inside the region of the virtual window.59. The method of claim 58 further comprising performing, by thecomputer, at least one measurement on the ultrasound image based atleast in part on the connecting line extending between the respectivelocations of the first and second cursors inside the region of thevirtual window.
 60. A method of operating portable medical ultrasoundimaging equipment, the portable medical ultrasound imaging equipmentincluding a transducer probe, a housing in a tablet form factor, thehousing having a front panel, a computer disposed in the housing, thecomputer including at least one processor and at least one memory, atouch screen display for displaying an ultrasound image, the touchscreen display being disposed on the front panel, and an ultrasoundbeamformer circuit disposed in the housing, the touch screen display andthe ultrasound engine being communicably coupled to the computer, themethod comprising the steps of: receiving, at the computer, a firstinput from the touch screen display; in response to the first input fromthe touch screen display, tracing a predetermined feature of theultrasound image; receiving, at the computer, a second input from thetouch screen display, the second input being received substantiallysimultaneously with a portion of the first input; and in response to thesecond input from the touch screen display, completing the tracing ofthe predetermined feature of the ultrasound image.
 61. The method ofclaim 60 wherein the first input corresponds to a press and drag gestureagainst the touch screen display.
 62. The method of claim 60 where inthe second input corresponds to a tap gesture against the touch screendisplay.
 63. The method of claim 60 further comprising receiving, at thecomputer, a third input from the touch screen display.
 64. The method ofclaim 63 wherein the third input corresponds to a double tap gestureagainst the touch screen display.
 65. The method of claim 63 furthercomprising in response to the third input from the touch screen display,displaying a first cursor inside a region of the touch screen display.66. The method of claim 65 further comprising receiving, at thecomputer, a fourth input from the touch screen display.
 67. The methodof claim 66 wherein the fourth input corresponds to a drag gesture onthe touch screen display.
 68. The method of claim 66 further comprisingin response to the fourth input from the touch screen display, movingthe first cursor to a first location inside the region of the touchscreen display.
 69. The method of claim 68 further comprising receiving,at the computer, a fifth input from the touch screen display, the fifthinput being received at the first location inside the region of thetouch screen display.
 70. The method of claim 69 wherein the fifth inputcorresponds to a press gesture against the touch screen display.
 71. Themethod of claim 69 further comprising receiving, at the computer, asixth input from the touch screen display, the sixth input beingreceived substantially simultaneously with the fifth input.
 72. Themethod of claim 71 wherein the sixth input corresponds to a tap gestureagainst the touch screen display.
 73. The method of claim 71 furthercomprising in response to the sixth input from the touch screen display,fixing the first cursor at the first location inside the region of thetouch screen display.
 74. The method of claim 73 wherein the tracing ofthe predetermined feature of the ultrasound image includes tracing thepredetermined feature of the ultrasound image, starting from the firstcursor at the first location inside the region of the touch screendisplay.
 75. The method of claim 60 further comprising performing, bythe computer, at least one measurement on the ultrasound image based atleast in part on the tracing of the predetermined feature of theultrasound image.